Editorial Commentary: The Shoulder Biceps Tendon and Baseball Continue Their Controversial Relationship

The optimal treatment of shoulder SLAP tears in high-level baseball players remains highly controversial. In pitchers, many SLAP lesions are found incidentally on magnetic resonance imaging and may in fact be adaptive to the baseball pitcher's mechanics of throwing. Surgical repair of SLAP lesions requires lengthy rehabilitation, and outcomes have been similar to or worse than the results after nonoperative treatment. The treatment option of biceps tenodesis is an appealing alternative to SLAP repair, but the indications and technique of biceps tenodesis in the elite pitcher still need to be defined.     

Outcomes of post burn flexion contracture release under tourniquet versus tumescent technique in children

Objective

To compare the clinical outcomes of release of flexion contractures after burn of the hand in children using tourniquet or tumescent technique in terms of operative time, postoperative pain score, and percentage of graft take.

Modification of Aortic Cannula With an Inlet Chamber to Induce Spiral Flow and Improve Outlet Flow

Physiologically, blood ejected from the left ventricle in systole exhibited spiral flow characteristics. This spiral flow has been proven to have several advantages such as lateral reduction of directed forces and thrombus formation, while it also appears to be clinically beneficial in suppressing neurological complications. In order to deliver spiral flow characteristics during cardiopulmonary bypass operation, several modifications have been made on an aortic cannula either at the internal or at the outflow tip; these modifications have proven to yield better hemodynamic performances compared to standard cannula. However, there is no modification done at the inlet part of the aortic cannula for inducing spiral flow so far. This study was carried out by attaching a spiral inducer at the inlet of an aortic cannula. Then, the hemodynamic performances of the new cannula were compared with the standard straight tip end‐hole cannula. This is achieved by modeling the cannula and attaching the cannula at a patient‐specific aorta model. Numerical approach was utilized to evaluate the hemodynamic performance, and a water jet impact experiment was used to demonstrate the jet force generated by the cannula. The new spiral flow aortic cannula has shown some improvements by reducing approximately 21% of impinging velocity near to the aortic wall, and more than 58% reduction on total force generated as compared to standard cannula.     

Interpretation of semen analysis using WHO 1999 and WHO 2010 reference values: Abnormal becoming normal

Reference values of WHO 1999 manual were used for the interpretation of semen analysis until 2010 when new reference values were introduced which have lower cut‐off compared to WHO 1999. Therefore, several men who previously were diagnosed abnormal based on their semen analysis have now become normal using new reference values. This study was conducted on semen analyses of 661 men from Middle East region and Pakistan. All semen analyses were reviewed using WHO 1999 and WHO 2010 criteria. Results showed that based on new criteria, 19% of the population changed classification from abnormal to normal when all normal semen parameters were considered. When at least one or more abnormal semen parameters were considered, of the total 661, 44% (288) of the population changed its classification from abnormal to normal with shift from WHO 1999 to 2010 criteria. These findings show that using new cut‐off values, many more men are considered normal, but using old criteria (WHO 1999), the same men would be classified as abnormal. This warrants further discussion over the investigations and management plans for patients whose semen analyses fall below WHO 1999 but above WHO 2010 cut‐offs.     

Mental stress assessment using simultaneous measurement of EEG and fNIRS

Previous studies reported mental stress as one of the major contributing factors leading to various diseases such as heart attack, depression and stroke. An accurate stress assessment method may thus be of importance to clinical intervention and disease prevention. We propose a joint independent component analysis (jICA) based approach to fuse simultaneous measurement of electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) on the prefrontal cortex (PFC) as a means of stress assessment. For the purpose of this study, stress was induced by using an established mental arithmetic task under time pressure with negative feedback. The induction of mental stress was confirmed by salivary alpha amylase test. Experiment results showed that the proposed fusion of EEG and fNIRS measurements improves the classification accuracy of mental stress by +3.4% compared to EEG alone and +11% compared to fNIRS alone. Similar improvements were also observed in sensitivity and specificity of proposed approach over unimodal EEG/fNIRS. Our study suggests that combination of EEG (frontal alpha rhythm) and fNIRS (concentration change of oxygenated hemoglobin) could be a potential means to assess mental stress objectively.OCIS codes: (350.2660) Fusion, (110.2960) Image analysis, (170.1610) Clinical applications     

Role of MMP-2, MMP-9 and VEGF as serum biomarker in early prognosis of renal cell carcinoma

Introduction

Renal cell carcinoma epitomizes a diversified group of tumors which contributes more than 15,000 deaths annually worldwide. In spite of tremendous efforts to identify prognostic factors apart from grade, histology and tumor size, they are not so obvious yet to fulfill the requirement. In this study, the prognostic role of serum matrix metalloproteinase (MMP)-2, 9, and vascular endothelial growth factor (VEGF) levels in patients with pre and postoperative renal cell carcinoma are evaluated to use as biomarker.

Prescribing conventional antipsychotics in the era of novel antipsychotics: informed consent issues

The goal of this study was to ascertain why patients are maintained on conventional antipsychotics and whether the risks/benefits and alternative treatments with novel antipsychotics are discussed with these patients. We reviewed the charts of 117 outpatients maintained on conventional antipsychotics at three New York hospitals: Hutchings Psychiatric Center (HPC), Syracuse Veterans Affairs Medical Center (SVA), and the Continuing Day Treatment Program (CDT). The major reasons for maintaining patients on conventional antipsychotics were good response (50%), patient choice (45%), and physician choice (36%). Despite the high incidence of tardive dyskinesia at all three hospitals (range: 12%-50%), physicians often did not discuss the risks/benefits of continuing conventional antipsychotics with the patients. The treating psychiatrist discussed alternative treatments with 37% of patients at SVA, 58% at HPC, and 68% at CDT (P = 0.066, df = 2, Pearson chi(2) test). For patients who are receiving any antipsychotic therapy, discussions about the risks/benefits of treatments are integral for optimal treatment and medicolegal purposes.     

Primary gastric lymphoma

AIM: The purpose of this review is to describe the variousaspects of primary gastric lymphoma and the treatmentoptions currently available. METHODS: After a systematic search of Pubmed, Medscape and MDconsult, we reviewed and retrieved literature regarding gastric lymphoma. RESULTS: Primary gastric lymphoma is rare however, the incidence of this malignancy is increasing. Chronic gastritis secondary to Helicobacterpylori(H pylon) infection has been considered a major predisposing factor for MALT lymphoma.Immune histochemical marker studies and molecular biology utilizing polymerase chain reaction have facilitated appropriate diagnosis and abolished the need for diagnostic surgical resection. Advances in imaging techniques including Magnetic Resonance Imaging (MRI) and Endoscopic UItrasonography (EUS) have helped evaluation of tumor extension and invasion.The clinical course and prognosis of this disease is dependent on histopathological sub-type and stage at the time of diagnosis. Controversy remains regarding the best treatment for early stages of this disease. Chemotherapy, surgery and combination have been studied and shared almost comparable results with survival rate of 70-90%. However, chemotherapy possesses the advantage of preserving gastric anatomy.Radiotherapy alone has been tried and showed good results.Stage ⅢE, IVE disease treatment is solely by chemotherapy and surgical resection has been a remote consideration. CONCLUSION: We conclude that methods of diagnosis and staging of the primary gastric lymphoma have dramatically improved. The modalities of treatment are many and probably chemotherapy is superior because of high success rate,preservation of stomach and tolerable complications.     

Prevalence of gestational diabetes mellitus in Kashmiri women from the Indian subcontinent

This prospective study was carried out to determine the prevalence of gestational diabetes mellitus (GDM) in Kashmiri women and to assess the effect of various demographic factors. Two thousand pregnant women (divided into groups A and B, being the first and last 1000 consecutive women) attending various antenatal clinics in six districts of Kashmir valley were screened for GDM by 1 h 50 g oral glucose challenge test. Four hundred and fourteen (20.8%) women (216 from group A and 198 from group B) had an abnormal screening test and proceeded to oral glucose tolerance testing. Women from group A had a 3 h 100 gram oral glucose tolerance test (OGTT) and GDM was as classified by Carpenter and Coustan. A 2 h 75 g OGTT was performed on group B subjects and WHO criteria applied for diagnosis of GDM. The overall prevalence of GDM was 3.8% (3.1% in group A versus 4.4% in group B-P-value 0.071). GDM prevalence steadily increased with age (from 1.7% in women below 25 years to 18% in women 35 years or older). GDM occurred more frequently in women who were residing in urban areas, had borne three or more children, had history of abortion(s) or GDM during previous pregnancies, had given birth to a macrosomic baby, or had a family history of diabetes mellitus. Women with obesity, hypertension, osmotic symptoms, proteinuria or hydramnios had a higher prevalence of GDM.