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The management of acute postoperative pain after rotator cuff surgery can be challenging. To our knowledge, there are no data available in the literature correlating satisfactory pain control with improvement in terms of function. The purposes of the present study were to evaluate: 1) pain pattern after arthroscopic rotator cuff repair in patients operated with two different techniques (transosseous vs transosseous equivalent); 2) safety/efficacy of three different pharmacological pain control strategies; 3) possible relationship between a correct shoulder pain management protocol in the early post-operative period and patients' functional improvement. 114 patients underwent rotator cuff tear repair, either with a Transosseus or a Transosseus equivalent technique. 62 (54%) were male and 52 (46%) were female. The average age was 59 ± 9 years. They were randomly assigned into three different pain management protocols: Paracetamol as needed (max 3 tablets/day) for 1 week (Protocol A), Paracetamol + Codein 1 tablet three times per day for 7 days (Protocol B), or Paracetamol + Ibuprofen 1 tablet two times per day for 7 days (Protocol C). Immediate passive mobilization of the operated shoulder was allowed. VAS and Passive Flexion values were recorded at 7 (T1), 15 (T2) and 30 (T3) days post-surgery. DASH values were recorded at 90 days post-surgery. All patients were asked to register any kind of signs/symptoms that may appear during drug assumption according to each pain management protocols. All the pain management protocols administered were well tolerated by all the study population, and no adverse signs/symptoms were highlighted during drug assumption. Pain pattern: in both surgical techniques, patients within Protocol A were associated with worst results in terms of mean VAS at each time point examined when compared to Protocol B and C (p < 0,05). In patients within Protocol A, no statistically significant differences were found at each point time examined comparing the two surgical techniques, with the exception of T2, where the TO was associated with an higher VAS value than TOE (p < 0.05). No differences were highlighted in Protocol B and C when comparing the values between two surgical techniques. ROM: in both surgical techniques, patients within Protocol A were associated with worst results in terms of mean PROM at each time point examined when compared to Protocol B and C (p < 0,05). In the TO group, patients within Protocol B had better PROM values at T1 (p < 0,05) and T2 (p < 0,05) compared to Protocol C, but no differences were highlighted at T3. In the TOE group, no statistically significant differences were found between patients within Protocol B and C at each time point examined. DASH: In the TO group, no statistically significant differences were found regarding the DASH values comparing Protocol B vs Protocol C, but they were highlighted comparing the values between Protocol A and Protocol B (p < 0,05), and between Protocol A and Protocol C (p < 0,05). Similar results were recorded in the TOE group. Post-operative pain is influenced by the surgical technique used being transosseous more painful in the first 15 days after surgery. Oral anti-inflammatory drugs are a feasible strategy to appropriately control post-operative pain. An association between Paracetamol and either Codein or Ibuprofen can lead to better outcomes in terms of VAS reduction and early recovery of passive ROM. [ABSTRACT FROM AUTHOR]

The so-called inerter is an attracting device that offers a solution to the goal of realizing or improving structural control devices with high mass ratios while avoiding the undesirable increase in dead load. The research presented here focuses on evaluating the performance of a fluid inerter in mitigating vertical vibrations of structures that exhibit multi-modal behavior, such as plates. First, a numerical study based on previous experimental data investigates the properties of the connection between the inerter and the structure to be controlled. Considering that a flexible connection has been shown to introduce a linearization effect, while a rigid connection of the inerter to the controlled structure can achieve significant displacement reductions, the influence of these two connection types over different inertance ratios is analyzed. To evaluate the practical suitability of the flexible connection to reduce the inherent nonlinear effects associated with the device, a novel application of the fluid inerter for vibration control in multi-modal structures is presented, exemplified by a cross-laminated timber panel, and compares its control performance with that of a conventional Tuned Mass Damper (TMD). This provides insight into the effectiveness of the inerter in controlling vertical vibrations. In addition, optimization procedures are employed to determine connection parameters that enhance the effectiveness of both the TMD and the inerter in mitigating vertical vibrations. • Assessment of the connection properties of a fluid inerter. • Experimental testing on a fluid inerter for vertical vibration control. • Performance control comparison with a traditional Tuned Mass Damper. • Optimization of the devices' for multi-modal structures control. [ABSTRACT FROM AUTHOR]

The fracture avulsion of the greater tuberosity (GT) represents 2% of all humerus fractures, but the true incidence is likely to be higher, being challenging the initial diagnosis on radiograph. The fracture avulsion of the GT could have different treatments: nondisplaced or minimally displaced fractures are treated conservatively, whereas for displaced or comminuted fractures surgical treatment is preferred. The most important finding of this study is the employment of an all-arthroscopic transosseous augmented technique for the treatment of a displaced humeral GT fracture avulsion. This technique shows all the advantages of the transosseous fixation and arthroscopic approach. [Display omitted] [ABSTRACT FROM AUTHOR]

Ubiquitination, a post-translational modification that involves a covalent attachment of ubiquitin to a protein substrate, is essential for cellular homeostatic maintenance. At the end of a three-enzyme cascade, E3 ubiquitin ligases (E3s) recruit substrates and promote or directly catalyze ubiquitin transfer to targets. These enzymes largely determine the specificity of the ubiquitination reaction. Genetic alteration, abnormal expression, or dysfunction of E3s account for the occurrence and progression of human cancers. Indeed, excessive degradation of relevant tumor-suppressor molecules and impaired disposal of oncogenic proteins have been linked to tumorigenesis. This review focuses on the emerging roles of HECT-type E3s in tumorigenesis, and emphasizes how perturbations of these enzymes contribute to cancer pathogenesis. The HECT-type E3 ubiquitin ligases constitute a small subfamily of E3s (28 enzymes in human) that have intrinsic enzymatic activity. Members of the subfamily of HECT-type E3s are frequently deregulated in human cancers. Aberrant expression, mutations, and deregulated activity of the HECT enzymes have been associated with cancer development and chemoresistance. HECT-type E3s contribute to tumorigenesis by regulating the ubiquitination levels of substrates that act as either tumor suppressors or oncogenes. Some HECT E3s behave as pro- or antioncogenic factors depending on the cellular context, substrate selectivity, and binding of adaptor proteins that may facilitate the recruitment of specific targets. [ABSTRACT FROM AUTHOR]

Purpose: To examine the number of viable stem cells contained in the postinjury effusion fluid and the waste byproducts of arthroscopic cruciate ligament surgery.Methods: This study included patients older than 18 years of age with acute (<5 weeks old) cruciate ligament injuries requiring arthroscopic surgery. The postinjury effusion fluid (effusion fluid), fat pad and cruciate ligament stump debridement tissue (byproduct tissue), and arthroscopic fluid collected during fat pad and/or stump debridement (byproduct fluid) were collected at the time of surgery from 30 individuals. Specimens were analyzed, investigating cell viability, nucleated cell counts, cell concentrations, colony-forming unit assays, and flow cytometry. Samples from the first 20 individuals were collected in small specimen containers, and samples from the last 10 individuals were collected in larger specimen containers.Results: Cells of the injury effusion exhibited the greatest viability (86.4 ± 1.31%) when compared with the small volume harvest byproduct tissue (50.2 ± 2.5%, P = .0001), small volume harvest byproduct fluid (48.8 ± 1.88%, P = .0001), large volume harvest byproduct tissue (70.1 ± 5.6%, P = .0001), and large volume harvest byproduct fluid (60.3 ± 3.41%, P = .0001). The culture analysis of fibroblast colony-forming units found on average 1916 ± 281 progenitor cells in the effusion fluid, 2488 ± 778 progenitor cells in the byproduct tissue, and 2357 ± 339 progenitor cells in the byproduct fluid. Flow cytometry confirmed the presence of immature cells and the presence of cells with markers typically expressed by known stem cell populations.Conclusions: Viable stem cells are mobilized to the postinjury effusion at the time of cruciate ligament injury and can be found in the byproduct waste of cruciate ligament surgery.Clinical Relevance: The methodology around effusion fluid and byproduct tissue capture during cruciate ligament surgery should be investigated further. Cell amounts available from these tissues with current technologies are not sufficient for immediate evidence-based clinical application. [ABSTRACT FROM AUTHOR]

Resveratrol, a polyphenol present in grapes and other edible plants, possesses several important pharmacological activities, including anticancer activity. Nevertheless, its therapeutic use is still limited because of some unfavourable physicochemical and pharmacokinetic properties, mainly, poor cellular uptake and too rapid metabolism resulting in elimination from the body. To meet these drawbacks, some resveratrol conjugates would be useful, which would possess improved stability, uptake and bioavailability than the lead compound, and the ability to release it once it is internalized into the cell. In this paper we report a synthetic strategy which allowed us to obtain new amphiphilic resveratrol derivatives starting from different selectively protected resveratrol phosphoramidites or even from the resveratrol triphosphoramidite. Specifically, resveratrol was conjugated through phosphate bridge(s) to different lipophilic groups related to membrane lipids, such as cholesteryl or diacylglycero moieties. All the new lipoconjugates were tested towards human neuroblastoma SH-SY5Y cells and proved to be significantly more active than resveratrol, with a concentration-dependent activity. [ABSTRACT FROM AUTHOR]

Background: Intrauterine devices, including levonorgestrel-releasing and copper devices, are highly effective long-acting reversible contraceptives. The potential risks associated with intrauterine devices are low and include uterine perforation and device expulsion.Objective: This study aimed to evaluate the risk of perforation and expulsion associated with levonorgestrel-releasing devices vs copper devices in clinical practice in the United States.Study Design: The Association of Perforation and Expulsion of Intrauterine Device study was a retrospective cohort study of women aged ≤50 years with an intrauterine device insertion during 2001 to 2018 and information on intrauterine device type and patient and medical characteristics. Of note, 4 research sites with access to electronic health records contributed data for the study: 3 Kaiser Permanente-integrated healthcare systems (Northern California, Southern California, and Washington) and 1 healthcare system using data from a healthcare information exchange in Indiana (Regenstrief Institute). Perforation was classified as any extension of the device into or through the myometrium. Expulsion was classified as complete (not visible in the uterus or abdomen or patient reported) or partial (any portion in the cervix or malpositioned). We estimated the crude incidence rates and crude cumulative incidence by intrauterine device type. The risks of perforation and expulsion associated with levonorgestrel-releasing intrauterine devices vs copper intrauterine devices were estimated using Cox proportional-hazards regression with propensity score overlap weighting to adjust for confounders.Results: Among 322,898 women included in this analysis, the incidence rates of perforation per 1000 person-years were 1.64 (95% confidence interval, 1.53-1.76) for levonorgestrel-releasing intrauterine devices and 1.27 (95% confidence interval, 1.08-1.48) for copper intrauterine devices; 1-year and 5-year crude cumulative incidence was 0.22% (95% confidence interval, 0.20-0.24) and 0.63% (95% confidence interval, 0.57-0.68) for levonorgestrel-releasing intrauterine devices and 0.16% (95% confidence interval, 0.13-0.20) and 0.55% (95% confidence interval, 0.44-0.68) for copper intrauterine devices, respectively. The incidence rates of expulsion per 1000 person-years were 13.95 (95% confidence interval, 13.63-14.28) for levonorgestrel-releasing intrauterine devices and 14.08 (95% confidence interval, 13.44-14.75) for copper intrauterine devices; 1-year and 5-year crude cumulative incidence was 2.30% (95% confidence interval, 2.24-2.36) and 4.52% (95% confidence interval, 4.40-4.65) for levonorgestrel-releasing intrauterine devices and 2.30% (95% confidence interval, 2.18-2.44) and 4.82 (95% confidence interval, 4.56-5.10) for copper intrauterine devices, respectively. Comparing levonorgestrel-releasing intrauterine devices with copper intrauterine devices, the adjusted hazard ratios were 1.49 (95% confidence intervals, 1.25-1.78) for perforation and 0.69 (95% confidence intervals, 0.65-0.73) for expulsion.Conclusion: After adjusting for potential confounders, levonorgestrel-releasing intrauterine devices were associated with an increased risk of uterine perforation and a decreased risk of expulsion relative to copper intrauterine devices. Given that the absolute numbers of these events are low in both groups, these differences may not be clinically meaningful. [ABSTRACT FROM AUTHOR]

On the basis of a preliminary screening of seven different samples of Sicilian grape pomace, the ‘Nerello Mascalese’ sample NM2 was selected for an ethanol preparative extraction. The defatted NM2 EtOH extract was subjected to DPPH and GAE assays, showing good radical scavenging activity (SC50 =9.9μg/mL) and a GAE value of 397.7mg/g extract. HPLC–DAD analysis of NM2 extract allowed a quantitative determination of the main anthocyanins (AN) and flavonols/flavonol glycosides (FL/FG). Aliquots of the NM2 extract were subjected to three different fractionation protocols (FP1, FP2 and FP3). The fractions were examined by DPPH and GAE assays, and subjected to HPLC–DAD analysis for the quantitative determination of the main AN and FL/FG. FP3 allowed obtaining a polyphenol-enriched fraction with SC50 =14.8μg/mL and GAE=184.1mg/g of fraction, accounting for only 1.3% in weight of the EtOH extract. Some considerations about the relationship between antioxidant activity and AN/FL/FG HPLC–DAD profiles are also reported. [Copyright &y& Elsevier]

Abstract: We have investigated the oxidative behavior of sterols such as cholesteryl acetate (1), 7-dehydrocholesteryl acetate (2), ergosteryl acetate (3), cholecalciferol acetate (Vitamin D3 acetate) (4) and ergocalciferol acetate (Vitamin D2 acetate) (5) with the oxidant system methyltrioxorhenium/H2O2/pyridine in order to check potential parameters controlling the selectivity. The reactions, performed in CH2Cl2/H2O at 25°C, have shown good regio- and stereoselectivity. All oxidation products were isolated by high-performance liquid chromatography (HPLC) and characterized by MS(EI) or FAB, 1H NMR, 13C NMR, APT, COSY, HSQC, HMBC, ROESY and NOEDS measurements. Seven new oxygenated compounds were also obtained. Under the experimental conditions adopted in this work, only the diene steroids, i.e. 7-dehydrocholesteryl acetate and ergosteryl acetate, undergo hydrolytic oxirane ring opening, whereas Vitamin D2 and D3 acetates, containing the triene system and cholesteryl acetate yield only epoxides. The selectivity seems to be controlled by the nucleophilicity of double bonds and by stereoelectronic and steric effects. [Copyright &y& Elsevier]

In this report, the LIF neural model driven by underthreshold sinusoidal signals but with a gaussian-distributed noise on the threshold, is approximated by suitably defining an instantaneous firing (or escape) rate, which depends only on the momentary value of the voltage variable. This allows us to obtain, by analytically solving the relevant equations, the main statistical functions describing the “firing activity”; namely, the probability density function of firing phases and that of interspike intervals. From these functions two quantities can be derived, whose dependence on the noise intensity allows the Stochastic Resonance (SR) to be demonstrated. Besides the “regular” SR, the analysed system was found to produce, either for low frequencies and large amplitudes of modulation or for high modulation frequencies, resonance curves displaying two peaks. This bimodal feature of the resonance curves is accounted for on the basis of phase locked firing patterns. [Copyright &y& Elsevier]

Summary The authors report the ultrasonographic evolution of the Achilles tendon healing process following a percutaneous tenorraphy technique. Thirty-eight patients affected with subcutaneous ruptures of the Achilles tendon underwent percutaneous tenorraphy and were followed-up with clinical examination and submitted to ultrasound study 5, 24 and 48 weeks after surgery. Ultrasound aids the clinical diagnosis especially when the diagnosis is doubtful (i.e. in presence of partial tears, observed in three cases) and in assessing the level of the rupture. Soon after surgery an increase of the diameter of the ruptured tendon was observed in comparison with uninjured tendon. One year postoperatively, the repaired tendon gradually decreased in thickness, even if the orientation of tendon fascicles was still not properly organized. In conclusion, ultrasonography confirmed its value as a diagnostic and prognostic instrument indicating the severity of the lesion and to evaluate the opposition of the tendon stumps and the tendon healing process also in this percutaneous tenorraphy. [ABSTRACT FROM AUTHOR]

Bone metastases to the foot are rare and often misdiagnosed. Only tarsal localizations are relatively frequent. Primary tumours are mostly adenocarcinomas (colon, kidneys, lungs). Three cases of acrometastases, localized, respectively, on the ungual phalanx of the hallux, the first metatarsal and the first cuneiform, are reported. Primitive tumour sites differed in the three cases (renal, pulmonary and mammary origin). Adequate therapy must be preceded by an accurate staging. Surgery should aim to excise the tumour and restore, when possible, a good function of the foot without any pain. Amputation should only be resorted to if is not possible to perform the excision of the tumour in patients whose life expectancy is not too short. Wide local and systemic diffusion of the tumour and a short life expectancy contraindicate any surgical approach. Treatment, in these cases, must try to achieve a satisfactory pain control and decrease the local expansion of the tumour. [ABSTRACT FROM AUTHOR]