Silence of the lungs: comparing measures of slow and non-communicating lung units from pulmonary function tests with computed tomography.

Multiple breath washout (MBW) has successfully assessed the silent lung zone particularly in cystic fibrosis lung disease, however, it is limited to the communicating lung only. There are a number of different pulmonary function methods that can assess what is commonly referred to as trapped air, with varying approaches and sensitivity. Twenty-five people with cystic fibrosis (pwCF) underwent MBW, spirometry, body plethysmography, and spirometry-controlled computed tomography (spiro-CT) on the same day. PwCF also performed extensions to MBW that evaluate air trapping, including our novel extension (MBWShX), which reveals the extent of under-ventilated lung units (UVLU). Additionally, we used 2 previously established 5-breath methods that provide a volume of trapped gas (VTG). We used trapped air % from spiro-CT as the gold standard for comparison. UVLU derived from MBWShX showed the best agreement with trapped air %, both in terms of correlation (RS 0.89, P<0.0001) and sensitivity (79%). Bland-Altman analysis demonstrated a significant underestimation of the VTG by both 5-breath methods (-249ml [95%CI -10796; 580ml] and -203ml [95%CI -997;591ml], respectively). Parameters from both spirometry and body plethysmography were sub-optimal at assessing this pathophysiology. The parameters from MBWShX demonstrated the best relationship with spiro-CT and had the best sensitivity compared to the other pulmonary function methods assessed in this study. MBWShX shows promise to assess and monitor this critical pathophysiological feature, which has been shown to be a driver of lung disease progression in pwCF.

Mimicking aneurysm in a patient with chronic occlusion of the left middle cerebral artery: A case report.

BACKGROUND: With the popularization of various cerebrovascular imaging methods and increased attention to the field, more cerebrovascular diseases are being detected in asymptomatic patients. Different cerebrovascular diseases are typically isolated but occasionally occur simultaneously, causing difficulties in diagnosis and treatment. Morphological changes in the collateral circulation of blood vessels in chronic cerebral artery occlusion patients are slow and dynamic, intercepting morphological development at a specific moment. Excessive reliance on single imaging tests such as digital subtraction cerebral angiography (DSA) can lead to misdiagnosis. CASE SUMMARY: We report a 52-year-old male who was admitted to our department for treatment of an unruptured aneurysm during a follow-up examination for brain trauma after 1 mo. Computed tomography (CT) scan was negative, but CT angiography (CTA) revealed a sac-like bulge at the bifurcation of the left middle cerebral artery. DSA revealed an unruptured aneurysm with unique scapular morphology. The stump of a middle cerebral artery occlusion was observed during exposure during aneurysm clipping surgery, and the diagnosis of chronic cerebral artery occlusion was confirmed intraoperatively. This case was confusing because of the peculiar morphology of the arterial stump and compensatory angiogenesis due to multiple cerebral artery stenoses observed on preoperative CTA and DSA. The surgery did not cause secondary damage to the patient, and medical treatment for risk factors was continued postoperatively. CONCLUSION: Multiple cerebral arterial stenoses can occur in conjunction with aneurysms or arteriovenous malformations, and their unique morphology can lead to misdiagnosis.

Career Length After Surgically Treated ACL Plus Collateral Ligament Injury in Elite Athletes.

BACKGROUND: Limited data are available regarding career length and competition level after combined anterior cruciate ligament (ACL) and medial- or lateral-sided surgeries in elite athletes. PURPOSE: To evaluate career length after surgical treatment of combined ACL plus medial collateral ligament (MCL) and ACL plus posterolateral corner (PLC) injuries in elite athletes and, in a subgroup analysis of male professional soccer players, to compare career length and competition level after combined ACL+MCL or ACL+PLC surgeries with a cohort who underwent isolated ACL reconstruction (ACLR). STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A consecutive cohort of elite athletes undergoing combined ACL+MCL and ACL+PLC surgery was analyzed between February 2001 and October 2019. A subgroup of male elite soccer players from this population was compared with a previously identified cohort having had isolated primary ACLR without other ligament surgery. A minimum 2-year follow-up was required. Outcome measures were career length and competition level. RESULTS: A total of 98 elite athletes met the inclusion criteria, comprising 50 ACL+PLC and 48 ACL+MCL surgeries. The mean career length after surgical treatment of combined ACL+MCL and ACL+PLC injuries was 4.5 years. Return-to-play (RTP) time was significantly longer for ACL+PLC injuries (12.8 months; P = .019) than for ACL+MCL injuries (10.9 months). In the subgroup analysis of soccer players, a significantly lower number of players with combined ACL+PLC surgery were able to RTP (88%; P = .003) compared with 100% for ACL+MCL surgery and 97% for isolated ACLR, as well as requiring an almost 3 months longer RTP timeline (12.9 months; P = .002) when compared with the isolated ACL (10.2 months) and combined ACL+MCL (10.0 months) groups. However, career length and competition level were not significantly different between groups. CONCLUSION: Among elite athletes, the mean career length after surgical treatment of combined ACL+MCL and ACL+PLC injuries was 4.5 years. Professional soccer players with combined ACL+PLC surgery returned at a lower rate and required a longer RTP time when compared with the players with isolated ACL or combined ACL+MCL injuries. However, those who did RTP had the same career longevity and competition level.

Collateral flow and pulsatility during large vessel occlusions: insights from a quantitative in vitro study.

Acute ischemic stroke caused by large vessel occlusions is being increasingly treated with neurovascular interventions. The hemodynamics within the collateral system of the circle of Willis (CoW) hemodynamics play a fundamental role in therapy success. However, transient in vivo data on pathological collateral flow during large vessel occlusions are not available. Moreover, there are no flow models that accurately simulate the hemodynamic conditions in the CoW during large vessel occlusions. We used a circulatory loop to generate highly reproducible cerebrovascular-like flows and pressures and used non-invasive flow visualization and high-resolution flow and pressure measurements to acquire detailed, time-dependent hemodynamics inside an anatomical phantom of the CoW. After calibrating a physiological reference case, we induced occlusions in the 1. middle cerebral artery, 2. terminal carotid artery, and 3. basilar artery; and measured the left posterior communicating artery flow. Mean arterial pressure and pulse pressure remained unchanged in the different occlusion cases compared to the physiological reference case, while total cerebral flow decreased by up to 19%. In all three occlusion cases, reversed flow was found in the left posterior communicating artery compared to the reference case with different flow magnitudes and pulsatility index values. The experimental results were compared with clinical findings, demonstrating the capability of this realistic cerebrovascular flow setup. This novel cerebrovascular flow setup opens the possibility for investigating different topics of neurovascular interventions under various clinical conditions in controlled preclinical laboratory studies.

Predictive value of early serum ACSL4 and ASITN/SIR grade for motor function recovery in patients with post-ischemic stroke lower limb neurological sequelae after modified constraint-induced movement therapy.

BACKGROUND: Ischemic stroke accounts for over 85 % of all stroke types. Acyl-CoA synthetase long chain family member 4 (ACSL4) is considered to promote myocardial and cerebral ischaemia/ reperfusion. However, up to now, no study focused on the role of ACSL4 in patients with post-stroke lower limb neurological sequelae. OBJECTIVE: The present study aimed to investigate the predictive value of ACSL4 and collateral circulation for lower limb neurological sequelae of ischemic stroke patients after modified constraint-induced movement therapy (mCIMT). METHODS: This is a prospective cohort study which included 99 ischemic stroke patients with lower limb neurological sequelae who were admitted to our hospital during January 2021 to December 2022. All patients received mCIMT after the admission. Collateral circulation was evaluated by digital subtraction angiography (DSA) and graded by the American Society of Interventional and Therapeutic Neuroradiology/ Society of Interventional Radiology (ASITN/SIR) grading system. Enzyme linked immunosorbent assay (ELISA) was used to detect serum ACSL4. Basic characteristics were collected and lower limb motor function was measured by Fugl-Meyer score (FMS), modified Ashworth score (MAS) and Brunnstrom stage, as well as timed up and go (TUG) test, ten-Meter walk test (10MWT), and six-minute walk test (6MWT) before and after treatment. RESULTS: Serum ACSL4 and percentage of patients with ASITN/SIR 0-1 decreased significantly after treatment compared with the values before treatment. Patients with higher baseline serum ACSL4 values at admission showed significantly lower FMS scores, higher TUG and 10MWT, as well as lower 6MWT. Patients with ASITN/SIR grade 0-1 at admission only showed significantly higher TUG and 10MWT, as well as lower 6MWT. Receiver operating characteristic (ROC) curves showed ACSL4 and ASITN/SIR grade could be used to predict the prognosis. Logistic regression found only national institutes of health stroke scores (NIHSS) was the independent risk factor for post-treatment motor impairment after mCIMT. CONCLUSION: Higher levels of ACSL4 and ASITN/SIR 0-1 are associated with poor recovery of motor functions of patients with post-stroke sequelae after mCIMT.

Flow reduction due to arterial catheterization during stroke treatment - A computational study using a distributed compartment model.

The effectiveness of various stroke treatments depends on the anatomical variability of the cerebral vasculature, particularly the collateral blood vessel network. Collaterals at the level of the Circle of Willis and distal collaterals, such as the leptomeningeal arteries, serve as alternative avenues of flow when the primary pathway is obstructed during an ischemic stroke. Stroke treatment typically involves catheterization of the primary pathway, and the potential risk of further flow reduction to the affected brain area during this treatment has not been previously investigated. To address this clinical question, we derived the lumped parameters for catheterized blood vessels and implemented a corresponding distributed compartment (0D) model. This 0D model was validated against an experimental model and benchmark test cases solved using a 1D model. Additionally, we compared various off-center catheter trajectories modeled using a 3D solver to this 0D model. The differences between them were minimal, validating the simplifying assumption of the central catheter placement in the 0D model. The 0D model was then used to simulate blood flows in realistic cerebral arterial networks with different collateralization characteristics. Ischemic strokes were modeled by occlusion of the M1 segment of the middle cerebral artery in these networks. Catheters of different diameters were inserted up to the obstructed segment and flow alterations in the network were calculated. Results showed up to 45% maximum blood flow reduction in the affected brain region. These findings suggest that catheterization during stroke treatment may have a further detrimental effect for some patients with poor collateralization.

Is There a Relationship Between Grip Strength and Injuries in Professional Baseball Players?

Background: Injuries in professional baseball players have become exceedingly common. Efforts to mitigate injury risk have focused on the kinetic chain, shoulder motion, and so forth. It is unclear whether grip strength is related to injury risk in professional baseball pitchers. Purpose/Hypothesis: The purpose of this study was to determine if grip strength was a risk factor for injury. It was hypothesized that pitchers with weaker grip strength would have a higher likelihood of sustaining a shoulder or elbow injury compared with pitchers with stronger grip strength. Study Design: Case-control study; Level of evidence, 3. Methods: All professional pitchers from a single Major League Baseball organization were included. Dominant and nondominant grip strength were measured after each pitching outing throughout the 2022 season. Injuries over the course of the season were recorded, and data were compared between pitchers who sustained a shoulder or elbow injury and those who did not. Results: Overall, 213 pitchers were included, of whom 53 (24.9%) sustained a shoulder or elbow injury during the season. The mean grip strength for all pitchers was 144.0 ± 20.8 lb (65.3 ± 9.4 kg). The mean dominant-arm grip strength was 142.6 ± 20.8 lb (64.7 ± 9.4 kg) for pitchers who did not sustain a shoulder or elbow injury and 148.2 ± 20.9 lb (67.2 ± 9.5 kg) for pitchers who did sustain an injury, with no significant group difference in grip strength (P > .05). Furthermore, there were no significant differences in change in grip strength over the course of the season between the groups. Conclusion: There was no significant difference in mean grip strength or change in grip strength over the course of a single season between professional baseball pitchers who sustained a shoulder or elbow injury and those who did not.

Rehabilitation of an Upper Extremity Weight-Bearing Athlete with an Ulnar Collateral Ligament Injury: A Case Report.

Background and Purpose: Ulnar collateral ligament (UCL) injury is a common elbow injury among overhead athletes, particularly baseball pitchers. However, limited research exists for non-throwing athletes, especially regarding rehabilitation. The purpose of this case report is to illustrate the use of early weight-bearing activities into the rehabilitation protocol for non-operative management of athletes with a UCL injury. Case Description: The subject was a 17-year-old female competitive cheerleader. Two weeks prior, during the performance of an acrobatic skill in which she transitioned to full upper extremity (UE) weight-bearing, she sustained an injury to her right elbow. Physical therapy examination findings indicated a diagnosis of a UCL sprain. Self-reported outcome measures revealed a FOTO score of 69/100 and a Quick Dash score of 43/100. The subject attended 14 therapy sessions over nine weeks to address physical function and performance, which were assessed at intervals during her therapy program. Rehabilitation consisted of therapeutic exercise for the progression of UE functional weight-bearing including planks, ball push-ups, handstands, crab walks, stool pulls, handstand walks, and UE plyometric jumps. Outcomes: Along with documented improvement of the standard musculoskeletal examination measures of range of motion, strength, and functional performance, the subject demonstrated no elbow instability and improved FOTO and Quick Dash scores of 98 and 0, respectively. The subject demonstrated 105% limb symmetry index with the return to sport (RTS) UE functional testing of one-armed seated shot-put throw (SSPT) and achieved normative values with the closed kinetic chain upper extremity stability test (CKCUEST). Conclusion: This case report highlights the successful treatment of a subject with a UCL injury and the integration of therapy interventions with a focus on UE weight-bearing. Further research on performing high level UE weight-bearing activities during rehabilitation and RTS guidelines is needed.

Microscopic Magnetic Resonance Imaging Comparing Asymptomatic and Symptomatic Ulnar Collateral Ligament Injuries in Baseball Players.

BACKGROUND: The relationship between abnormalities of the ulnar collateral ligament (UCL) on magnetic resonance imaging (MRI) and elbow symptoms in baseball players remains unclear. PURPOSE/HYPOTHESIS: This study aimed to compare findings of the UCL on microscopic MRI between asymptomatic and symptomatic elbows in baseball players. We hypothesized that the MRI grade of UCL injuries would exhibit no correlation with medial elbow symptoms in baseball players. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: The study participants were skeletally mature baseball players who underwent high-resolution microscopic MRI of the medial elbow including for medical checkups. Elbows with previous surgical treatment or traumatic UCL injuries were excluded. The patients were divided into symptomatic and asymptomatic groups. The UCL appearance on microscopic MRI was categorized into 4 grades and compared between the groups. Abnormal findings in the medial elbow including bony fragments at the medial epicondyle, osteophytes or bony fragments in the sublime tubercle, and bone marrow edema (BME) in the sublime tubercle were also evaluated. RESULTS: A total of 426 baseball players (426 elbows) with a mean age of 20 years (range, 14-41 years) were included. The asymptomatic and symptomatic groups included 158 and 268 elbows, respectively. In the asymptomatic group, based on MRI grading of the UCL, 46 (29%) elbows were rated as grade I, 64 (41%) as grade II, 40 (25%) as grade III, and 8 (5%) as grade IV. In the symptomatic group, 75 (28%) elbows were rated as grade I, 118 (44%) as grade II, 61 (23%) as grade III, and 14 (5%) as grade IV. There was no significant difference in the MRI grades between the groups (P = .9). BME in the sublime tubercle was more frequently seen in the symptomatic group than in the asymptomatic group (P < .001). CONCLUSION: There was no difference in MRI grades of the UCL between symptomatic and asymptomatic elbows in baseball players; approximately 30% of elbows demonstrated high-grade UCL injuries in both groups. BME in the sublime tubercle was more frequently seen in symptomatic elbows than in asymptomatic elbows. BME in the sublime tubercle was a better indicator of symptoms than was MRI grading of the UCL.

Combined procedure using a double flap as a surgical option for coarctation of the aorta with delayed diagnosis.

Simple coarctation of the aorta is repaired in an infant by direct end-to-end anastomosis of the aorta or subclavian flap aortoplasty. However, some cases are not detected until late childhood. For school-age patients, greater consideration must be given to risks such as postoperative limb ischemia and the potentially harmful effects of any artificial material on future growth. Here, we describe our technique for these patients, in whom the value of direct anastomosis is uncertain, to minimize the amount of synthetic graft material used while achieving successful anatomical repair.

Route patterns of the collateral venous pathway in patients with tumors invading the superior sagittal sinus: an angiographic study and clinical applications.

Chronic occlusion of the superior sagittal sinus (SSS) by tumors in the midsagittal region causes the collateral venous pathway (CVP). Understanding common patterns of CVP is helpful in reducing surgical complications. This study aimed to investigate the CVP found in patients with SSS-invading tumors, and to provide information on the prevention of operative venous complications. From January 2015 to December 2022, this retrospective study collected patients with tumors that invaded the SSS and underwent digital subtraction angiography of intracranial vessels. Data collected included sex, age, tumor pathology, tumor location along the SSS, tumor side, degree of obstruction of the SSS, types and route patterns of the CVP, and the distance between the tumor and the diploic vein (DV). Twenty patients (6 males, 14 females) were recruited. The prevalence of CVP types was 90% for DV, 35% for end-to-end anastomosis of superficial cortical vein, 15% for meningeal vein, and 20% for other types of CVP. The pteriofrontoparietal and occipitoparietal diploic routes were found on the cerebral hemisphere contralateral to the tumor significantly more than in the cerebral hemisphere ipsilateral to the tumor. Of all patients with presence of collateral DV, 61% had a very close (less than 1 cm) distance between the nearest DV and tumor attachment in the SSS. DV in the cerebral hemisphere contralateral to the tumor was the most common type of CVP found in patients with tumor-induced SSS obstruction. Most of the collateral DV was located very close to the SSS tumor attachment. Neurosurgeons should realize these findings when planning a craniotomy.

A computational study of how an α- to γ-motoneurone collateral can mitigate velocity-dependent stretch reflexes during voluntary movement.

The primary motor cortex does not uniquely or directly produce alpha motoneurone (α-MN) drive to muscles during voluntary movement. Rather, α-MN drive emerges from the synthesis and competition among excitatory and inhibitory inputs from multiple descending tracts, spinal interneurons, sensory inputs, and proprioceptive afferents. One such fundamental input is velocity-dependent stretch reflexes in lengthening muscles, which should be inhibited to enable voluntary movement. It remains an open question, however, the extent to which unmodulated stretch reflexes disrupt voluntary movement, and whether and how they are inhibited in limbs with numerous multiarticular muscles. We used a computational model of a Rhesus Macaque arm to simulate movements with feedforward α-MN commands only, and with added velocity-dependent stretch reflex feedback. We found that velocity-dependent stretch reflex caused movement-specific, typically large and variable disruptions to arm movements. These disruptions were greatly reduced when modulating velocity-dependent stretch reflex feedback (i) as per the commonly proposed (but yet to be clarified) idealized alpha-gamma (α-γ) coactivation or (ii) an alternative α-MN collateral projection to homonymous γ-MNs. We conclude that such α-MN collaterals are a physiologically tenable propriospinal circuit in the mammalian fusimotor system. These collaterals could still collaborate with α-γ coactivation, and the few skeletofusimotor fibers (ß-MNs) in mammals, to create a flexible fusimotor ecosystem to enable voluntary movement. By locally and automatically regulating the highly nonlinear neuro-musculo-skeletal mechanics of the limb, these collaterals could be a critical low-level enabler of learning, adaptation, and performance via higher-level brainstem, cerebellar, and cortical mechanisms.

Fastball Quality After Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers.

BACKGROUND: The ulnar collateral ligament (UCL) is essential for elbow stability during pitching. In professional baseball, the fastball (FB) is the most commonly used pitch, making postrecovery FB performance after UCL reconstruction (UCLR) a crucial aspect to consider. HYPOTHESES: (1) Pitchers undergoing UCLR would show no significant changes in performance metrics compared with nonoperated pitchers with similar FB velocity and spin rate, and (2) no significant variance would be found in these metrics within the operated pitchers concerning their preinjury anthropometric characteristics and pitching performance metrics. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: The study included 91 Major League Baseball (MLB) pitchers who underwent primary UCLR between January 1, 2015, and December 31, 2021. A matched 1:1 control group of MLB pitchers without UCLR injuries was established. Publicly available pitch metrics and anthropometric data were compared between the study and control groups. RESULTS: Disparities in several performance metrics emerged during the first postreturn year (PRY1), including FB use percentage (P = .029), fielder independent pitching (FIP) (P = .021), and standardized FB runs above average per 100 pitches (wFB/C) (P < .001). Subgroup analysis within the UCLR group revealed a negative correlation between presurgery mean FB velocity and its subsequent change (P < .001) and a positive correlation with changes in FIP (P = .025) from the index year to PRY1. A negative correlation was observed between FB use percentage in the index year and its change by PRY1 (P = .002). By the second postreturn year, no significant differences were found in these performance metrics. No factors were significantly related to prolonged recovery time. CONCLUSION: Although FB velocity and spin rate remained consistent, significant differences were observed in FB use percentage, FIP, and wFB/C in PRY1. However, by second postreturn year, these differences were no longer significant. No specific risk factors were identified concerning prolonged recovery time between pre-UCLR FB pitching metrics and the physical anthropometric data. These results suggest that although the short-term postsurgery period may affect more specialized pitching metrics, the basic pitching performance metrics, as hypothesized, remain largely unaffected by UCLR.

Long non-coding RNA SNHG12 regulates leptomeningeal collateral remodeling via RGMa after ischemic stroke.

Leptomeningeal anastomoses or pial collateral arteries are crucial for restoring cerebral blood flow (CBF) after an ischemic stroke. Vascular smooth muscle cells (VSMCs) are hypothesized to regulate the extent of this adaptive response, while the specific molecular mechanisms underlying this process are still being investigated. SNHG12, a long non-coding RNA, has been shown to influence several diseases related angiogenesis, including osteosarcoma and gastric cancer. However, the role of SNHG12 in contractile VSMC dedifferentiation during collateral arteriogenesis-related strokes remains unclear. Here we demonstrated that SNHG12 is a positive regulator of MMP9 and VSMC dedifferentiation, which enhances pial collateral arteriogenesis following cerebrovascular occlusion. Pial collateral remodeling is limited by the crosstalk between SNHG12-MMP9 signaling in VSMCs, which is mediated through repulsive guidance molecule a (RGMa) regulation. Thus, targeting SNHG12 may represent a therapeutic strategy for improving collateral function, neural tissue health, and functional recovery following ischemic stroke.

Ulnar collateral ligament repair in professional baseball players.

Background: While initial reports of surgical repair of ulnar collateral ligament tears are promising, studies detailing post-repair outcomes are lacking. This study explores the effectiveness of ulnar collateral ligament (UCL) repair in returning professional baseball players to their pre-injury level of play. Our hypothesis is that professional baseball players undergoing UCL repair will have successful outcomes and high return to sport rates after surgery. Methods: Publicly available databases were utilized to search for data on professional baseball players who underwent UCL repair from 2016 to 2021. Players undergoing primary UCL repair with an internal brace were included. Amateur players were excluded as were those undergoing revision UCL repair or UCL reconstruction. Results: Of the 11 pitchers who underwent UCL repair, minor league baseball (MiLB) pitchers returned to the sport at an average of 17.5 months. MiLB pitchers had similar earned run averages (ERAs), games played, innings pitched, and walks plus hits per inning pitched ratios (WHIPs) before and after surgery. Four major league baseball (MLB) pitchers (80%) returned to the sport at 9.55 months. MLB pitchers played fewer games and pitched fewer innings than before the surgery, but their ERAs and WHIPs were similar before and after surgery. Pitch velocity and spin rates after surgery varied based on pitch type. The seven positional players who underwent UCL repair showed no differences in batting or fielding performance before and after surgery. Conclusions: UCL repair can successfully return both pitchers and positional players at both the MiLB and MLB levels to play at pre-injury performance levels. Repair can be considered as an option for qualifying injuries in players hoping to maximize performance after surgery with minimal recovery time. Level of Evidence: IV.

Taking the Road Less Travelled: A Case Report of Distal Splenic Artery Embolisation via the Pancreaticoduodenal Arcade in Splenic Trauma With Celiac Artery Stenosis.

Celiac axis stenosis (CAS) is one of the most prevalent splanchnic arterial pathologies. It seldom results in clinically severe ischemic bowel disease because of the rich collateral circulation from the superior mesenteric artery. Knowledge about the collaterals in celiac artery stenosis guides various interventional procedures. Here, we describe a case of a 19-year-old female with American Association for the Surgery of Trauma (AAST) grade IV splenic injury found to have CAS. Distal splenic artery embolisation was performed via the collateral pathway through the pancreaticoduodenal arcade.

Association of Cerebral Hypoperfusion and Poor Collaterals with Cognitive Impairment in Patients with Severe Vertebrobasilar Artery Stenosis.

Background: Effect of stenosis of vertebrobasilar artery (VBA) on cognitive function is elusive. Objective: To investigate association of cerebral hypoperfusion and poor collaterals with vascular cognitive impairment (VCI) in severe VBA stenosis patients. Methods: We consecutively enrolled patients with severe VBA stenosis confirmed by digital subtraction angiography who underwent computed tomographic perfusion (CTP) and cognitive assessments. Patients were divided into poor or good collaterals groups according to the collateral circulation status, and were grouped into different perfusion groups according to CTP. Cognitive function was measured by Montreal Cognitive Assessment (MoCA), Clock Drawing Test, Stroop Color Word Test, Trail Making Test, Digital Span Test, Auditory Verbal Learning Test, and Boston Naming Test scales. The association of cerebral perfusion and collaterals with VCI were explored. Results: Among 88 eligible patients, VCI occurred in 51 (57.9%) patients experienced. Poor collateral was present in 73 (83.0%) patients, and hypoperfusion in 64 (72.7%). Compared with normal perfusion patients, the odds ratio with 95% confidence interval for VCI was 12.5 (3.7-42.4) for overall hypoperfusion, 31.0 (7.1-135.5) for multiple site hypoperfusion, 3.3 (1.0-10.5) for poor collaterals, and 0.1 (0-0.6) for presence of posterior communicating artery (PcoA) compensated for posterior cerebral artery (PCA) and basilar artery (BA). Additionally, decreased scores of cognitive function tests occurred in patients with decompensated perfusion or poor collaterals. Conclusions: Hypoperfusion and poor collaterals were positively associated with cognitive impairment in patients with severe VBA. However, PcoA compensated for the PCA and BA had a protective role in cognitive impairment development.

Fluoroscopic-Guided Barbotage and Corticosteroid Injection for the Treatment of Symptomatic Calcification of the Lateral Collateral Ligament: A Case Report.

Periarticular calcification of the knee joint is a rare pathology that may be challenging to diagnose and manage when symptomatic. Here, we describe the first use of fluoroscopic-guided percutaneous needle aspiration and lavage (barbotage) with corticosteroid injection in a case of symptomatic calcification of the lateral collateral ligament (LCL). A 75-year-old female presented with acute lateral knee pain and stiffness, which subsequent radiographic imaging and diagnostic injection confirmed to be attributed to calcification within the LCL. Initial treatment with analgesic medications and a genicular nerve block failed to alleviate symptoms. However, complete resolution of symptoms was achieved following fluoroscopic-guided barbotage and steroid injection. This case underscores the importance of considering LCL calcification in the differential diagnosis of lateral knee pain. This case also illustrates the potential effectiveness of barbotage and adjunctive steroid injection as a minimally invasive treatment option for symptomatic LCL calcification, emphasizing the need for more rigorous studies evaluating treatment strategies for managing periarticular calcifications involving the knee joint.

Overarm Training Tolerance: A Pilot Study on the Use of Muscle Oxygen Saturation as a Biomarker.

Ulnar collateral ligament (UCL) tears occur due to the prolonged exposure and overworking of joint stresses, resulting in decreased strength in the flexion and extension of the elbow. Current rehabilitation approaches for UCL tears involve subjective assessments (pain scales) and objective measures such as monitoring joint angles and range of motion. The main goal of this study is to find out if using wearable near-infrared spectroscopy technology can help measure digital biomarkers like muscle oxygen levels and heart rate. These measurements could then be applied to athletes who have been injured. Specifically, measuring muscle oxygen levels will help us understand how well the muscles are using oxygen. This can indicate improvements in how the muscles are healing and growing new blood vessels after reconstructive surgery. Previous research studies demonstrated that there remains an unmet clinical need to measure biomarkers to provide continuous, internal data on muscle physiology during the rehabilitation process. This study's findings can benefit team physicians, sports scientists, athletic trainers, and athletes in the identification of biomarkers to assist in clinical decisions for optimizing training regimens for athletes that perform overarm movements; the research suggests pathways for possible earlier detection, and thus earlier intervention for injury prevention.

The major league baseball pitch clock: First year analysis of pitcher injuries.

Introduction: Recently, star pitchers in Major League Baseball (MLB) have faced devastating elbow injuries, causing some to question whether implementation of the MLB pitch clock during the 2023 season has led to a higher rate of elbow injuries among pitchers. This study aims to determine if implementation of the MLB pitch clock in the 2023 MLB season affected the injury rate in pitchers. Methods: Injury data was collected for the 2021, 2022, and 2023 MLB seasons using the fangraphs.com injury database. Incidence rate ratio was calculated to compare the injury rate for the 2023 season to the 2021 and 2022 seasons. A z-test for proportions was used to determine significance levels. Results: The 2023 season showed a decrease in the rate of the total number of injuries when compared to the 2021 (P = 0.01) and 2022 (P = 0.02) seasons. There was no statistical difference in the rate of Tommy John Surgery, Flexor Tendon Injuries, or other cause elbow injuries. Conclusion: Following implementation of the MLB pitch clock during the 2023 season, the total number of injuries decreased, but there was no change in the rate of elbow injuries in pitchers compared with the 2021 and 2022 MLB seasons. Future studies are needed to determine if the pitch clock has a longitudinal effect on injuries.