Pathologically confirmed pancreatic hamartoma after surgical resection with an aldosterone-producing adrenal tumor: a case report.

Pancreatic hamartoma is a benign tumor of the pancreas with an extremely low incidence and is commonly diagnosed by pathologic examination after surgery. This report describes the case of a 57-year-old female who was referred for the evaluation of a pancreatic mass and an adrenal incidentaloma. Further imaging studies suggested pancreatic neuroendocrine tumor and aldosterone-producing adrenal tumor. Pylorus-preserving pancreaticoduodenectomy was performed with the initial impression of a pancreatic neuroendocrine tumor. However, pathology results revealed a pancreatic hamartoma. Multiple endocrine neoplasia type 1 syndrome was discussed as a probable explanation for tumor masses in both the pancreas and adrenal gland.

Assessment of the proarrhythmic effects of repurposed antimalarials for COVID-19 treatment using a comprehensive in vitro proarrhythmia assay (CiPA).

Due to the outbreak of the SARS-CoV-2 virus, drug repurposing and Emergency Use Authorization have been proposed to treat the coronavirus disease 2019 (COVID-19) during the pandemic. While the efficiency of the drugs has been discussed, it was identified that certain compounds, such as chloroquine and hydroxychloroquine, cause QT interval prolongation and potential cardiotoxic effects. Drug-induced cardiotoxicity and QT prolongation may lead to life-threatening arrhythmias such as torsades de pointes (TdP), a potentially fatal arrhythmic symptom. Here, we evaluated the risk of repurposed pyronaridine or artesunate-mediated cardiac arrhythmias alone and in combination for COVID-19 treatment through in vitro and in silico investigations using the Comprehensive in vitro Proarrhythmia Assay (CiPA) initiative. The potential effects of each drug or in combinations on cardiac action potential (AP) and ion channels were explored using human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) and Chinese hamster ovary (CHO) cells transiently expressing cardiac ion channels (Nav1.5, Cav1.2, and hERG). We also performed in silico computer simulation using the optimized O'Hara-Rudy human ventricular myocyte model (ORd model) to classify TdP risk. Artesunate and dihydroartemisinin (DHA), the active metabolite of artesunate, are classified as a low risk of inducing TdP based on the torsade metric score (TMS). Moreover, artesunate does not significantly affect the cardiac APs of hiPSC-CMs even at concentrations up to 100 times the maximum serum concentration (Cmax). DHA modestly prolonged at APD90 (10.16%) at 100 times the Cmax. When considering Cmax, pyronaridine, and the combination of both drugs (pyronaridine and artesunate) are classified as having an intermediate risk of inducing TdP. However, when considering the unbound concentration (the free fraction not bound to carrier proteins or other tissues inducing pharmacological activity), both drugs are classified as having a low risk of inducing TdP. In summary, pyronaridine, artesunate, and a combination of both drugs have been confirmed to pose a low proarrhythmogenic risk at therapeutic and supratherapeutic (up to 4 times) free Cmax. Additionally, the CiPA initiative may be suitable for regulatory use and provide novel insights for evaluating drug-induced cardiotoxicity.

Dissonance in views between healthcare professionals and adults with a spinal cord injury with their understanding and interpretation of exercise intensity for exercise prescription.

Objectives: To evaluate the difference between healthcare professionals (HCPs) and adults with spinal cord injury (SCI) in Asia regarding knowledge and interpretation of 'exercise intensity' for aerobic exercise prescription. Methods and study design: A survey was distributed to practising HCP and adults with SCI. It was completed in participants' local language on topics related to the importance of exercise frequency, intensity, time and type; methods for monitoring and terms related to exercise intensity prescription. χ2 analysis was used to detect differences in HCP or those with SCI. Results: 121 HCP and 107 adults with an SCI ≥1 years (C1-L4) participated. Responses revealed 61% of all HCP ranked 'intensity' being most important whereas only 38% respondents from the SCI group ranked it as high importance (p=0.008). For those with SCI, 'frequency' was most important (61%) which was significantly higher than the 45% selected by HCPs (p=0.030). Of the 228 respondents on average only 34% believed that the terms, 'moderate' and 'vigorous' provided enough information for aerobic exercise intensity prescription. HCP most often used HR methods compared with the SCI group (90% vs 54%; p<0.01). Both groups frequently used the subjective measures of exercise intensity, for example, Ratings of Perceived Exertion (8%3 vs 76% for HCP and SCI), HCP also frequently used speed (81%) and SCI also frequently relied on 'the affect' or feelings while exercising (69%). Conclusions: These differences must be considered when developing clinical-practice exercise guidelines and health referral educational pathways for adults with SCI in Asia.

Efficacy of Adductor Canal Block on Medial Knee Pain in Patients with Knee Osteoarthritis: A Randomized Single-Blind Placebo-Controlled Study.

BACKGROUND: This study aimed to confirm the efficacy of ultrasound-guided adductor canal block (ACB) as a treatment option for medial knee pain caused by knee osteoarthritis (KOA). METHODS: In total, 31 participants with medial knee pain due to KOA were randomized to either the ACB (ultrasound-guided ACB, n = 15) or placebo group (1 mL of 1% lidocaine, n = 16). The primary outcome was a numerical rating scale (NRS) for knee pain intensity comparing before and 4 weeks after injection. The secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), average daily number of analgesics consumed, average daily opioid consumption, and Timed Up and Go (TUG) test results before and 4 weeks after injection. RESULTS: Participants' baseline characteristics were not significantly different between the groups, except for age. At 4 weeks post-injection, the NRS score in the ACB group significantly improved compared to that in the placebo group (p = 0.009). However, the WOMAC, average daily number of analgesics consumed, average daily opioid consumption, and TUG test results did not show significant differences. CONCLUSION: ACB can be an effective treatment for reducing medial knee pain in patients with KOA.

Transforming growth factor­ß family and stem cell­derived exosome therapeutic treatment in osteoarthritis (Review).

Osteoarthritis (OA), although extensively researched, still lacks an effective and safe treatment. The only current treatment option available for advanced OA is joint replacement surgery. This surgery may pose the risks of persistent pain, surgical complications and limited implant lifespan. Transforming growth factor (TGF)­ß has a crucial role in multiple cellular processes such as cell proliferation. Any deterioration in TGF­ß signaling pathways can have an immense impact on OA. Owing to the crucial role of TGF­ß in cartilage homeostasis, targeting it could be an alternative therapeutic approach. Additionally, stem cell­based therapy has recently emerged as an effective treatment strategy that could replace surgery. A number of recent findings suggest that the tissue regeneration effect of stem cells is attributed to the paracrine secretion of anti­inflammatory and chondroprotective mediators or trophic factors, particularly nanosized extracellular vesicles (i.e., exosomes). Literature searches were performed in the MEDLINE, EMBASE, Cochrane Library and PubMed electronic database for relevant articles published before September 2021. Multiple investigators have confirmed TGF­ß3 as a promising candidate which has the chondrogenic potential to repair articular cartilage degeneration. Combining TGF­ß3 with bone morphogenetic proteins­6, which has synergistic effect on chondrogenesis, with an efficient platform such as exosomes, which themselves possess a chondroprotective function, offers an innovative and more efficient approach to treat injured cartilage. In addition, multiple findings stating the role of exosomes in chondroprotection has also verified a similar fact showing exosomes may be a more favorable choice than the source itself. In the present review, the importance of TGF­ß family in OA and the possibility of therapeutic treatment using stem cell­derived exosomes are described.

Cultural validation and language translation of the scientific SCI exercise guidelines for use in Indonesia, Japan, Korea, and Thailand.

CONTEXT: Indonesia, Japan, Korea, Thailand. OBJECTIVE: To culturally validate and translate the Scientific Exercise Guidelines for Adults with Spinal Cord Injury (SEG-SCI) for use in four Asian countries. DESIGN: Systematic Review. PARTICIPANTS: N/A. METHODS: A systematic review was conducted to identify all published English- and local-language studies conducted in Indonesia, Japan, Korea, and Thailand, testing the effects of exercise training interventions on fitness and cardiometabolic health in adults with acute or chronic SCI. Protocols and results from high-quality controlled studies were compared with the SEG-SCI. Forward and backward translation processes were used to translate the guidelines into Bahasa Indonesian, Japanese, Korean and Thai languages. RESULTS: Fifteen studies met the review criteria. At least one study from each country implemented exercise prescriptions that met or exceeded the SEG-SCI. Two were controlled studies. In those two studies, relative to control conditions, participants in exercise conditions achieved significant improvements in fitness or cardiometabolic health outcomes only when the exercise intervention protocol met or exceeded the SEG-SCI. During the language translation processes, end-users confirmed that SEG-SCI language and terminology were clear. CONCLUSION: Clinical researchers in Indonesia, Japan, Korea and Thailand have implemented exercise protocols that meet or exceed the SCI-SEG. Results of high-quality studies align with the SEG-SCI recommendations. Based on this evidence, we recommend that the SEG-SCI be adopted in these countries. The cultural validation and translation of the SEG-SCI is an important step towards establishing consistent SCI exercise prescriptions in research, clinical and community settings around the world.

Functional improvement of bilateral frozen shoulder by unilateral intra-articular corticosteroid injection: a retrospective study.

OBJECTIVE: Bilateral frozen shoulder (FS) is often treated with intra-articular corticosteroid injection (IACI). No studies have been performed to establish whether IACI must be administered in both shoulders or in only one shoulder to improve function. This study was therefore performed to determine whether unilateral IACI improves shoulder pain and passive range of motion (pROM) in bilateral FS. METHODS: The medical records of 165 patients with bilateral primary FS who underwent ultrasonography-guided IACI (2 mL of 10-mg/mL triamcinolone acetonide mixed with 5 mL of 1% lidocaine) in one shoulder were retrospectively reviewed. The outcome measures, namely the numeric rating scale (NRS) scores and pROM values (abduction, external rotation, flexion, hyperextension, and internal rotation), were evaluated pre- and post-injection. RESULTS: The patients' mean age was 54.0 ± 8.0 years. The mean symptom duration was 6.5 ± 2.8 months. The mean follow-up period after injection was 6.7 ± 0.8 weeks. The NRS scores and pROM values significantly improved in both the injected and non-injected shoulders. CONCLUSIONS: This study showed that unilateral IACI in patients with bilateral FS improves the clinical outcome of the non-injected shoulder. We suggest that physicians observe the non-injected shoulder after unilateral injection rather than performing bilateral injections.

Takotsubo syndrome as an overlooked and elusive cause of a single episode of dyspnea in young women: a case report.

BACKGROUND: Dyspnea is a common symptom in patients presenting to the emergency department. It has a variety of causes that range from non-urgent to life-threatening. One episode of dyspnea in a healthy young person is easy to overlook. However, if the symptoms occur after physically or emotionally stressful events, careful evaluation needs to be undertaken because it may be associated with Takotsubo syndrome, which is rarely expected but can be fatal. Herein, we report the case of Takotsubo syndrome in a healthy young woman who arrived at the emergency department after experiencing a short single episode of dyspnea following a minor surgery. CASE PRESENTATION: A 23-year old woman with no underlying chronic disease underwent closed reduction surgery for a nasal bone fracture under general anesthesia (with sevoflurane as the anesthetic). Approximately 5 h later, she presented to the emergency department with dyspnea, which improved soon upon arrival at the emergency department. There were no other symptoms. The dyspnea occurred about 5 h after being discharged on observation, with an uneventful postoperative course. Her electrocardiogram and chest X-ray findings were unremarkable. On testing, troponin I and creatine kinase myocardial band levels were elevated at 6.122 ng/mL and 11.2 µg/L (reference ranges: 0.000-0.046 ng/mL and 0.0-5.0 µg/L), respectively. Bedside echocardiography revealed an ejection fraction of 25%, with mid-ventricular and apical akinesia and basal hyperkinesia. The pulmonary and coronary angiographic computed tomographic scans were unremarkable. Hence, apical Takotsubo syndrome was suspected. A follow-up echocardiogram taken 5 days after admission showed full recovery with a normalized ejection fraction (60%) and no regional wall motion abnormality. The patient was discharged on the sixth day with no other complications. CONCLUSION: When atypical symptoms, such as transient dyspnea, manifest, it becomes necessary to suspect and diagnose Takotsubo syndrome to ensure timely and appropriate medical management, especially when a preceding stressful event, such as minor surgery has occurred. It might be helpful to perform bedside point-of-care echocardiography to check for regional wall motion abnormalities that are typically associated with Takotsubo syndrome.

Risk Assessment of Recurrence and Autoimmune Disorders in Kikuchi Disease.

PURPOSE: Kikuchi disease (KD) is typically a benign disease. Recent studies reporting recurrence or serious cases suggest a possible association of KD with systemic autoimmune disorders. We performed a long-term analysis of the characteristics of KD in patients of all ages and assessed KD recurrence or progress to systemic autoimmune disorders. PATIENTS AND METHODS: Electronic medical records of patients diagnosed with KD between April 1995 and May 2017 were reviewed for clinical and laboratory manifestations. RESULTS: In total, 480 patients were confirmed to have KD based on histopathology findings. The mean age at KD diagnosis was 24.4 years. Recurrence occurred in 11.3% of patients; 2.7% developed autoimmune diseases after KD diagnosis. Patients who experienced recurrence had more extranodal symptoms, lymphopenia, and a longer lymphopenia-recovery duration. Patients who developed autoimmune diseases after KD were more likely to have extranodal symptoms, KD recurrence, and anti-nuclear antibody positivity. CONCLUSION: KD patients with risk factors need to be followed-up for KD recurrence and the development of systemic autoimmune diseases.

Discrimination between pain and contracture in limited passive motion patients with rotator cuff tear: A STROBE-compliant cross-sectional study.

Either pain or contracture may limit shoulder passive range of motion (PROM) in patients with rotator cuff disease, and an appropriate treatment may be determined according to its cause. If there is no change in PROM under general anesthesia, contracture, rather than pain, may be the underlying condition. Our goal was to devise a physical examination that would help discriminate between pain and contracture in limited PROM patients with rotator cuff tear.This is a STROBE-compliant cross-sectional study. Patients with rotator cuff tears (N = 28) were scheduled for arthroscopic repair. The main outcome measure was PROM, including flexion, external rotation (ER), and abduction obtained by a blinded examiner before and after the induction of general anesthesia, and the abduction/ER ratio was calculated. In order to perform a subgroup analysis, patients were divided into 2 groups, one where abduction difference after the general anesthesia was 8°≤ (n = 22) and the other 8°> (n = 6).Patients' average age (62.6 ±â€Š7.2 years), symptom duration (13.0 ±â€Š10.0 months), intensity of shoulder pain on a visual analog scale (4.8 ±â€Š2.1), and Constant-Murley functional score (63.4 ±â€Š8.9); the ratio of gender (male: female = 12:16); and the arthroscopic findings were recorded. According to the correlation analysis, the abduction/ER ratio before general anesthesia was correlated best with the change in PROM after general anesthesia (correlation coefficient -0.74, P < .001); the correlations for abduction and flexion were -0.69 and -0.57, respectively (P < .001 and .002, respectively). The age, gender, height, weight, duration of symptoms, trauma history, visual analog score for shoulder pain, Constant-Murley functional score, size of rotator cuff tear, and biceps pathology did not differ significantly between the 2 groups in the subgroup analysis (P > .05). The only significant difference between the 2 groups was in the synovitis status (P = .04).Patients with greater abduction/ER ratio before anesthesia exhibited fewer PROM changes after anesthesia. The abduction/ER ratio was strongly and inversely correlated with PROM changes, allowing physicians to choose an appropriate treatment for limited PROM in patients with rotator cuff tears.

Relation between preoperative electromyographic activity of the deltoid and upper trapezius muscle and clinical results in patients treated with reverse shoulder arthroplasty.

BACKGROUND: If patients susceptible to poor clinical outcomes could be predicted before reverse shoulder arthroplasty (RSA), it would help to set reasonable postsurgical patient expectations in the preoperative setting. Our hypothesis was that the preoperative electromyographic (EMG) activity of the deltoid and upper trapezius muscles would be correlated with clinical outcomes of patients undergoing RSA. METHODS: EMG activity of the deltoid and upper trapezius muscles was measured in 25 patients scheduled to undergo RSA during 3 motions: shrugging, forward flexion, and abduction. Their postoperative clinical results were assessed prospectively during regular outpatient visits, including strength, active range of motion (ROM), pain, and functional scores. The correlations between the preoperative EMG activities and clinical results were analyzed. RESULTS: Postoperative shoulder strength after RSA was increased in patients with greater preoperative EMG activity of the middle deltoid and upper trapezius. Preoperative EMG activity of the anterior or middle deltoid muscle was associated with active ROM in flexion or abduction, whereas EMG activity of the posterior deltoid was associated with active ROM in external rotation. CONCLUSIONS: Shoulder strength after RSA was positively correlated with preoperative EMG activity of the deltoid and upper trapezius. Active ROM after RSA was positively correlated with preoperative EMG activity of the deltoid. Therefore, preoperative EMG measurements of the deltoid and upper trapezius may predict clinical outcomes after RSA.

Effect of Tissue Transglutaminase on Steroid Resistance in T-Cell Acute Lymphoblastic Leukemia.

AIM: To improve survival in patients with glucocorticoid-resistant T-cell acute lymphoblastic leukemia (T-ALL), it is critical to develop new therapeutic strategies to overcome steroid resistance. MATERIALS AND METHODS: Biochemical and molecular methodologies were used to evaluate whether tissue transglutaminase (TG2) confers steroid resistance in T-ALL. RESULTS: T-ALL cells were found to express elevated levels of TG2. Models of steroid-adapted subclones of T-ALL cell lines which were notably less sensitive to steroids than the parental cells. The steroid-adapted subclones showed increased TG2 expression and nuclear factor-κB (NF-κB) activity compared to T-ALL parental cells. Inhibition of TG2 suppressed steroid resistance and improved steroid cytotoxicity in steroid-adapted subclones of T-ALL in association with reduced NF-κB activity. CONCLUSION: TG2 may serve as a new target to overcome steroid resistance in T-ALL.

Early Intra-articular Corticosteroid Injection Improves Pain and Function in Adhesive Capsulitis of the Shoulder: 1-Year Retrospective Longitudinal Study.

BACKGROUND: Intra-articular corticosteroid injection is a commonly used therapy for adhesive capsulitis, but not enough studies exist on the optimal timing of the injection. OBJECTIVE: To determine whether intra-articular corticosteroid injection has better outcomes in patients with earlier stage than later stage of adhesive capsulitis. STUDY DESIGN: Retrospective longitudinal study SETTING: University-affiliated tertiary care hospital. PARTICIPANTS: Primary adhesive capsulitis patients (n=339) who were unresponsive to at least 1 month of conservative treatment and who had ultrasound-guided corticosteroid injection. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASUREMENTS: Visual analogue scale, Shoulder Pain and Disability Index, and passive range of motion (flexion, abduction, external rotation, and internal rotation and extension) were evaluated at pretreatment, month 1 and 12 after the first injection. RESULTS: The result of the multiple regressions, which considered the main and the interaction effect of confounding variables, showed that the differences of all outcomes in both short-term effect at month 1 and long-term effect at month 12 are greater when the duration of pain prior to injection is shorter. Among the confounders, the injection number in the difference of internal rotation and extension between month 0 and 12 (IRE Δ(0-12)) was statistically significant. IRE Δ(0-12) was also greater when the pain duration was shorter, though the decrease in IRE Δ(0-12) differed depending on the number of injections. CONCLUSIONS: Early injection improves outcomes of adhesive capsulitis at both short- and long-term follow-ups. If pain persists despite non-invasive and conservative treatments, early injection may be considered to shorten its natural history. LEVEL OF EVIDENCE: III.

Blending Face Details: Synthesizing a Face Using Multiscale Face Models.

Creating realistic 3D face models is a challenging problem in computer graphics because humans are so sensitive to facial abnormalities. The authors propose a method to synthesize a 3D face model using weighted blending of multiscale details from different face models. Using multiscale continuous displacement maps (CDMs), they achieve full correspondences across multiple scales in the parameter space. Their results demonstrate detail transfer across faces with highly different proportions, such as between humans and nonhuman creatures. An artist evaluation also indicated the proposed approach is intuitive and easy to use.

Effect of adductor canal block on medial compartment knee pain in patients with knee osteoarthritis: Retrospective comparative study.

Knee osteoarthritis (KOA) is a common disease in middle-aged and elderly people. Pain is the chief complaint of symptomatic KOA and a leading cause of chronic disability, which is most often found in medial knees. The aim of this study is to evaluate the efficacy of pain relief and functional improvement in KOA patients treated with ultrasound-guided adductor canal block (ACB).This is a 3-month retrospective case-controlled comparative study. Two hundred patients with anteromedial knee pain owing to KOA that was unresponsive to 3-month long conservative treatments. Ninety-two patients received ACB with 9 mL of 1% of lidocaine and 1 mL of 10 mg triamcinolone acetonide (ACB group), and 108 continued conservative treatments (control group). The main outcome measure was visual analog scale (VAS) of the average knee pain level for the past one week. Secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the timed up and go test, numbers of analgesic ingestion per day, and opioid consumption per day.During the 3-month follow-up, 86 patients in ACB group and 92 in control group were analyzed. There was no significant difference, with the exception of the duration of symptoms, between the 2 groups in age, sex, body mass index, and Kellgren-Lawrence grade. Repeated-measures analysis of variance and post hoc tests showed improvement of VAS (at month 1), WOMAC (at month 1), and opioid consumption per day (at month 1 and 2) in ACB group. No adverse events were reported.To our knowledge, this is the first study to assess the efficacy of ACB for patients with KOA. ACB is an effective and safe treatment and can be an option for patients who are either unresponsive or unable to take analgesics.

Capsule-Preserving Hydrodilatation With Corticosteroid Versus Corticosteroid Injection Alone in Refractory Adhesive Capsulitis of Shoulder: A Randomized Controlled Trial.

OBJECTIVE: To determine whether capsule-preserved hydrodilatation with corticosteroid improves pain and function in patients with refractory adhesive capsulitis (AC) better than intra-articular corticosteroid injection (IACI) alone. DESIGN: Prospective randomized controlled study. SETTING: University-affiliated tertiary care hospital. PARTICIPANTS: Subjects with primary AC (N=64) with shoulder pain level of visual analog scale (VAS) score ≥5, even after the initial administration of IACI alone. INTERVENTIONS: Participants randomly received ultrasound-guided IACI alone with 1mL of 40mg/mL triamcinolone acetonide and 3mL of 1% lidocaine (n=32) or ultrasound-guided capsule-preserved hydrodilatation with corticosteroid with a mixture of 1mL of 40mg/mL triamcinolone acetonide, 6mL of 1% lidocaine, and normative saline (n=32). MAIN OUTCOME MEASURES: The primary outcome measure was the Shoulder Pain and Disability Index score. Secondary outcomes were the VAS of shoulder pain level and angles of shoulder passive range of motion, including flexion, abduction, extension, external rotation, and internal rotation at pretreatment and weeks 3, 6, and 12 of posttreatment. RESULTS: There were no significant differences between the 2 groups in terms of demographic characteristics (age, sex, duration of symptoms, shoulder affected, and body mass index) at baseline. Repeated-measures analysis of variance showed significant effect of time in all outcome measurements in both groups. However, group-by-time interactions were not significantly different for any of the outcomes between groups. CONCLUSIONS: This study shows that compared with pretreatment, all outcome measures improved significantly in both groups by time; however, there was no significant difference between the 2 groups. Therefore, we recommend IACI alone over capsule-preserved hydrodilatation with corticosteroid when considering the corticosteroid injection as a secondary option after the initial IACI fails to improve symptoms for patients with refractory AC.

Polydeoxyribonucleotide Injection in the Treatment of Chronic Supraspinatus Tendinopathy: A Case-Controlled, Retrospective, Comparative Study With 6-Month Follow-Up.

OBJECTIVE: To determine the efficacy of polydeoxyribonucleotide (PDRN) injection for rotator cuff disease (RCD). DESIGN: Case-controlled, retrospective, comparative study. SETTING: Outpatient clinic at a university-affiliated tertiary care hospital. PARTICIPANTS: Patients (N=106) with chronic nontraumatic refractory RCD who were unresponsive to at least 1 month of conservative treatment: 55 patients received PDRN injection (PDRN group) and 51 continued conservative treatment (control group). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Shoulder Pain and Disability Index, score on a visual analog scale of the average shoulder pain level, number of analgesic ingestions per day, isometric strength of shoulder abductor, active range of motion (flexion, abduction, internal rotation, external rotation), and maximal tear size of tendon on ultrasonography at pretreatment and 3 and 6 months postinjection. RESULTS: There was no significant difference between the 2 groups in terms of age, sex, shoulder affected, duration of symptoms, and ultrasonographic findings at pretreatment. Compared with the control group, the treatment group showed a significant improvement in Shoulder Pain and Disability Index, visual analog scale score, and number of analgesic ingestions per day. However, there was no difference in isometric strength, active range of motion, and maximal tear size of tendon. No adverse events were reported. CONCLUSIONS: To our knowledge, this is the first study to assess the efficacy of PDRN injection for patients with RCD. The PDRN injection group showed improvement in pain and subjective disability in patients with RCD and continued to show improvement for 3 months thereafter; the PDRN injection can be an optional treatment for patients with chronic RCD who show no response to other treatments.

Relation Between Subacromial Bursitis on Ultrasonography and Efficacy of Subacromial Corticosteroid Injection in Rotator Cuff Disease: A Prospective Comparison Study.

OBJECTIVE: To evaluate the correlations between subacromial bursitis (bursal thickening and effusion) on ultrasonography and its response to subacromial corticosteroid injection in patients with rotator cuff disease. DESIGN: Prospective, longitudinal comparison study. SETTING: University-affiliated tertiary care hospital. PARTICIPANTS: Patients with rotator cuff disease (N=69) were classified into 3 groups based on ultrasonographic findings; (1) normative bursa group (group 1, n=23): bursa and effusion thickness <1mm; (2) bursa thickening group (group 2, n=22): bursa thickness >2mm and effusion thickness <1mm; and (3) bursa effusion group (group 3, n=24): bursa thickness <1mm and effusion thickness >2mm. INTERVENTION: A single subacromial injection with 20mg of triamcinolone acetonide. MAIN OUTCOME MEASURES: Visual analog scale (VAS) of shoulder pain, Shoulder Disability Questionnaire (SDQ), angles of active shoulder range of motion (flexion, abduction, external rotation, and internal rotation), and bursa and effusion thickness at pre- and posttreatment at week 8. RESULTS: There were no significant differences between the 3 groups in demographic characteristics pretreatment. Groups 2 and 3 showed a significant difference compared with group 1 in changes on the VAS and abduction; group 3 showed a significant difference compared with group 1 in changes of the SDQ, internal rotation, and external rotation; and all groups showed significant differences when compared with each other (groups 1 and 3, 2 and 3, and 1 and 2) in changes of thickness. CONCLUSIONS: A patient with ultrasonographic observation of subacromial bursitis, instead of normative bursa, can expect better outcome with subacromial corticosteroid injection. Therefore, we recommend a careful selection of patients using ultrasonography prior to injection.

Electromyographic Activities of the Rotator Cuff Muscles During Walking, Eating, and Washing.

OBJECTIVE: The aim of this study was to evaluate the activity of rotator cuff (RC) muscles during activities of daily living. DESIGN: Motion analysis was conducted with 14 volunteers. Activation of RC (subscapularis, supraspinatus, and infraspinatus) was assessed using electromyography (EMG). Walking was performed with or without a shoulder immobilizer. Eating was conducted with or without the support of the elbow with the contralateral hand. Washing the hair was simulated while standing or leaning forward; washing the body was simulated while standing or holding the elbow; and washing the face was simulated using both hands while leaning forward. RESULTS: During walking, RC's peak EMG activities remained below 7% maximum voluntary isometric contraction at all times, regardless of the use of immobilizers. Eating caused mild EMG activities (14%-32%), whereas eating with elbow support resulted in significantly lower EMG activities in the supraspinatus and infraspinatus. Washing the hair standing moderately activated RC (23%-57%), whereas leaning forward decreased it to 6% to 36%. Washing the body while holding the elbow decreased infraspinatus activation to 4% from 10% when standing. Washing the face with both hands and leaning forward resulted in high-peak EMG activities in the upper subscapularis (37%). CONCLUSIONS: There was no difference in RC activity level between walking with or without immobilizers. From the point of muscle contraction, an immobilizer is not mandatory. Holding the elbow with the contralateral hand while eating or washing can help decrease the load in the supraspinatus and infraspinatus.

Evaluation of surgeon's muscle fatigue during thoracoscopic pulmonary lobectomy using interoperative surface electromyography.

BACKGROUND: The aim of this study was to document the physical stress experienced by a surgeon during thoracoscopic pulmonary lobectomy and mediastinal lymph node dissection for lung cancer by measuring the intraoperative electromyography (EMG). METHODS: Surface EMG was recorded during 12 cases of thoracoscopic lobectomy. During the operation, 16 channels of a wireless EMG were used to measure muscle activity and fatigue from the bilateral muscles of the splenius capitis (SC), upper trapezius (UT), middle deltoid (MD), flexor carpi radialis (FCR), extensor carpi radialis (ECR), lumbar erector spinae (LES), rectus femoralis (RF), and tibialis anterior (TA). The EMG signals were processed to collect the values of the root mean square for muscle activity and median frequency (MF) for muscle fatigue. RESULTS: All operations were completed without adverse events. The mean operating time was 99.16±35.15 minutes. During the operation, the mean muscle activity of all muscles was 21.91±12.85 mV. High muscle activity was observed in the bilateral FCR and ECR, whereas low muscle activity was observed in the bilateral SC and LES. The final MFs in the bilateral SC and LES were found to be decreased from the initial status, which implied increased muscle fatigue. The muscles of the right and left LES were significantly fatigued by up to 29% and 37% compared to their initial status (P=0.021 and P=0.007, respectively). The MFs of the bilateral LES decreased with time (an average decreases of 0.008/5 minutes, P=0.002 in right LES and 0.004/5 minutes, P=0.018 in left LES). CONCLUSIONS: During thoracoscopic lobectomy, muscle fatigue was observed in muscles related to a static posture, such as the bilateral SC, UT, and ES. Further studies are required to investigate the ergonomic adjustments needed to reduce muscle fatigue in these static muscles.