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Rotator cuff (RTC) injuries are common in master athletes, especially overhead athletes. Risk factors include aging and degeneration as nonmodifiable and volume of activity, muscle weakness, and loss of motion as modifiable. The clinical presentation involves limited range of motion (ROM), pain at rest and at night. Injury classification into traumatic versus nontraumatic and tendinopathy, partial or full-thickness tears helps to establish a treatment plan. RTC injury rehabilitation protocols are criteria-based, multimodal, and divided into four phases. The acute phase addresses pain, inflammation, ROM, and RTC protection. The recovery phase addresses kinetic chain abnormalities, flexibility, and strength, and the functional phase involves exercises directed toward specific sport activities. Return to sports is based on clinical recovery, kinetic chain principles, and adequate sports technique. Nonsurgical management is recommended in most cases, and surgical management is considered if symptoms progress, especially for full-thickness tears.

Introducción: El craving o deseo es un estado que se manifiesta cuando una persona con un grado de dependencia hacia el alcohol entra en un periodo de abstinencia, este es el síntoma central de las conductas adictivas cuya intensidad suele relacionarse con la evolución del paciente y su presencia asume una gran influencia en la persistencia de las mismas. Al presentarse con una gran intensidad se constituye en una de las principales causas de la “recaída”, o reincidencia del paciente en el consumo de alcohol. Objetivo: caracterizar el nivel de Craving predominante en las usuarias que reciben tratamiento y residencian en dos clínicas de adicciones para mujeres de la ciudad de Cuenca y a su vez asociarlo con las variables sociopsicológicas planteadas como la edad, instrucción y estado civil. Materiales y Métodos: La metodología de investigación predominante será la cuantitativa, de tipo descriptivo, cohorte transversal, muestreo no probabilístico y una muestra intencional de 32 mujeres voluntarias no remuneradas en un rango de edad de entre 18 a 52 años. La prueba de identificación de Trastornos Relacionados con el Consumo de Alcohol, fue la utilizada en la caracterización del trastorno en el uso de alcohol, permitiendo seleccionar a las mujeres sujetos de investigación con dependencia alcohólica, subsiguientemente se aplicó la escala multidimensional de craving de alcohol. Resultados: un 53,1% de nivel intenso de craving, evidenciando una mayor prevalencia en las mujeres solteras con un 64,7%, con un rango de edad que oscila entre los 18 a 29 años y un nivel académico de bachillerato general unificado. Conclusiones: Se pudo constatar que las mujeres, sujetos del estudio, al entrar en proceso de abstinencia muestran manifestación de craving, desencaden´ndose en niveles leve, moderado o intenso, evidenciándose de forma significativa el nivel moderado o intenso.

The paper presents the geometric design of a new lattice element of conformal type integrated into the cooling system of an injection mold. The geometric variables of this element are parameterized and are included in the design of the mold cooling system so that it can be valid for any type of geometry of plastic parts. Similarly, a physical model is presented to analyze the energetic behavior of the cooling lattice. Through the application of expert-type optimization algorithms to the presented physical model, the geometrical variables of the cooling lattice are dimensioned as well as the technological variables that govern the cooling phase of the plastic part. This methodology has been applied to four plastic parts with different geometrical characteristics. The results obtained have been compared with numerical simulations carried out by means of CFD-type software for plastic parts analysis, concluding that the new cooling lattices are adapted to the design criteria of an optimal cooling system. The new cooling lattices improve, in turn, the efficiency of thermal exchange in the cooling phase for plastic parts with large concavities, fine details, internal turrets, and housings. A simplified model focused on the energy analysis of a single cooling cell has been defined, which allows us to evaluate the thermal exchange between the cooling lattice and the plastic part, avoiding the computational complexity in the generation of the discrete mesh of the mold inserts. Similarly, in order to guarantee the structural safety of the cooling grids, a numerical mechanical analysis of the structural behavior of the injection mold insert under the most unfavorable contour conditions during the injection process has been carried out. The new conformal system presented in the paper does not require expert designers for its dimensioning, considering it as an adequate tool for reducing the overall design time of the mold while allowing the manufacturing process to be more efficient, reducing cycle time, and increasing the quality of the parts produced.

Environmental pollution is nowadays the first risk factor associated with the development of lung cancer, stroke, and heart disease. Within the universe of the complex mix of pollutants that shape the environment, the importance of endocrine-disrupting compounds (EDCs), such as bisphenols, phthalates, polycyclic aromatic hydrocarbons (PAHs), and pesticides, has been highlighted in recent years because of our chronic and ubiquitous exposition, particularly by ingestion of food and water, and their interference in hormone and immune functions. EDCs are associated principally with breast cancer development, but there is a poor understanding of the relationship with other neoplasms such as colorectal cancer (CRC). The objective of this chapter is to address the potential carcinogenic role of EDCs in the development of CRC, focusing on inflammation and neuroendocrine-immune regulation. First, we will describe the interaction between inflammatory bowel disease and CRC in terms of disruption of intestinal permeability, dysbiosis, and immune response induced by EDCs. Moreover, we delve into the neuroendocrine axes involved in the progression of this pathology.

*Maurer AH, Burshteyn M, Adler LP, Steiner RM. How to differentiate benign versus malignant cardiac and paracardiac 18F FDG uptake at oncologic PET/CT. RadioGraphics. 2011;31:1287–1305.

The cost of corrosion remains a sizeable budgetary concern across the Department of Defense. Naval aviation and material are particularly impacted due to their mission profiles. As such, ongoing re...

Many psychiatric disorders are associated with cognitive dysfunction that is ineffectively treated by existing pharmacotherapies and which may contribute to poor real-world functioning. D-cycloserine (DCS) is a partial N-methyl- D -aspartate (NMDA) agonist that has attracted attention because of its cognitive enhancing properties, including in people with post-traumatic stress disorder (PTSD). Here, we examined the effect of DCS on reversal learning - a type of cognitive flexibility – following exposure to single prolonged stress (SPS), a rodent model of PTSD . Male Sprague Dawley rats ( n = 64) were trained to press levers in an operant chamber, matched for performance and assigned to SPS or control (unstressed) groups. Following SPS, rats received three additional lever press sessions, followed by a side bias test on day three. One day later they learned a response discrimination rule (press left or right lever, opposite to side bias) and on a subsequent day were trained (and tested) for reversal to the opposite lever. DCS (15 mg/kg) or vehicle was administered 30 minutes prior to the reversal session. No between-group differences were found in acquisition or retrieval of the initial rule, but a significant drug x stress interaction on response discrimination reversal indicated that DCS had a greater beneficial effect on SPS rats’ cognitive flexibility than it did on performance in controls. These findings add to a growing literature on the beneficial effects of DCS for treating a wide variety of deficits that develop following exposure to extreme stress and may have implications for the development of novel pharmacotherapies for PTSD.

Introduction. Endoscopic papillary large balloon dilatation (EPLBD) is an alternative for the treatment of common bile duct (CBD) stones. Existing evidence of factors associated with its outcomes is contradictory.Objective. To identify predictors (including the experience of an endoscopist) of success and adverse events in EPLBD.Methods. We reviewed the first 200 EPLBD with endoscopic sphincterotomy (EST) performed at our center. Demographic, clinical, and anatomic variables were studied, as well as the performance characteristics, correlating them with individual and group experience.Results. Global success was obtained in 87% of cases, and adverse events occurred in 16% of cases. Success was associated with stone size, CBD diameter, and the need to perform mechanical lithotripsy (ML). Despite that adverse events were not univariately associated with any factor, severe adverse events were more likely to occur in stones > 13.5 mm. Multivariate analysis which disclosed success was higher when ML was not required and stones were Conclusions. Success of EPLBD-EST is higher in stones

Recently, pathogenic variants in the MLL2 gene were identified as the most common cause of Kabuki (Niikawa-Kuroki) syndrome (MIM#147920). To further elucidate the genotype-phenotype correlation, we studied a large cohort of 86 clinically defined patients with Kabuki syndrome (KS) for mutations in MLL2. All patients were assessed using a standardized phenotype list and all were scored using a newly developed clinical score list for KS (MLL2-Kabuki score 0-10). Sequencing of the full coding region and intron-exon boundaries of MLL2 identified a total of 45 likely pathogenic mutations (52%): 31 nonsense, 10 missense and four splice-site mutations, 34 of which were novel. In five additional patients, novel, i.e. non-dbSNP132 variants of clinically unknown relevance, were identified. Patients with likely pathogenic nonsense or missense MLL2 mutations were usually more severely affected (median 'MLL2-Kabuki score' of 6) as compared to the patients without MLL2 mutations (median 'MLL2-Kabuki score' of 5), a significant difference (p

Background. Nucleoside reverse-transcriptase inhibitor (NRTI)-related mitochondrial toxicity has been suggested as a key factor in the induction of antiretroviral-related lipoatrophy. This study aimed to evaluate in vivo the effects of NRTI withdrawal on mitochondrial parameters and body fat distribution. Methods. A multicenter, prospective, randomized trial assessed the efficacy and tolerability of switching to lopinavir-ritonavir plus nevirapine (nevirapine group; n = 34), compared with lopinavir-ritonavir plus 2 NRTIs (control group; n = 33) in a group of human immunodeficiency virus-infected adults with virological suppression. A subset of 35 individuals (20 from the nevirapine group and 15 from the control group) were evaluated for changes in the mitochondrial DNA (mtDNA) to nuclear DNA ratio and cytochrome c oxidase (COX) activity after NRTI withdrawal. Dual-energy X-ray absorptiometry (DEXA) scans were used to objectively quantify fat redistribution over time. Results. The nevirapine group experienced a progressive increase in mtDNA content (a 40% increase at week 48; P = .039 for comparison between groups) and in the COX activity (26% and 32% at weeks 24 and 48, respectively; P = .01 and P = .09 for comparison between groups, respectively). There were no statistically significant between-group differences in DEXA scans at week 48, although a higher fat increase in extremities was observed in the nevirapine group. No virologic failures occurred in either treatment arm. Conclusions. Switching to a nucleoside-sparing regimen of nevirapine and lopinavir-ritonavir maintained full antiviral efficacy and led to an improvement in mitochondrial parameters, which suggests a reversion of nucleoside-associated mitochondrial toxicity. Although DEXA scans performed during the study only revealed slight changes in fat redistribution, a longer follow-up period may show a positive correlation between reduced mitochondrial toxicity and a clinical improvement of lipodystrophy.

Percutaneous Catheter Cryoablation in Man.Introduction: Recent animal studies demonstrated the feasibility and safety of applying percutaneous catheter cryoablation technology for ablation of arrhythmogenic sites. The studies also showed that reversible “ice mapping” can be performed before creating permanent lesions. We investigated the feasibility and safety of applying this new technology in man. Methods and Results: Cryoablation of the AV node (AVN) using a 9-French quadripolar catheter with a 4-mm electrode tip was attempted in 12 patients (mean age 67.8 ± 11.4 years) with refractory atrial fibrillation. Whereas technical issues prevented adequate tissue contact in two patients, complete AVN block was obtained in the remaining 10 patients after 4.8 ± 1.9 cryoapplications lasting 5.5 ± 0.2 minutes resulting in temperatures of −58.1°± 5.4°C. In all patients with sinus rhythm at the time of the procedure, cryomapping at warmer temperatures induced reversible AVN block and allowed confirmation of a successful site before definitive ablation. Intracardiac echocardiography was performed in three patients and allowed visualization of the cryocatheter-endocardial contact and cryolesion formation. No major procedural complications were reported. After 6 months of follow-up, 8 of 10 initially successful patients remained in complete block; 1 had partial recovery of AVN conduction manifested by atrial fibrillation with a slow ventricular response, and 1 fully recovered AVN conduction. Conclusion: (1) Catheter cryoablation of the AVN can be performed safely in man. (2) Reversible cryomapping is feasible and may offer an advantage over radiofrequency ablation. (3) Cryocatheterendocardial contact and cryolesion growth can be monitored with intracardiac echocardiography.

Alternative thermochemical cycles are considered promising technological solutions for hydrogen production and, in the context of the sustainable energy concept, can become a crucial part of industrial infrastructure. The medium temperature thermochemical cycles, which occur at temperatures below 600°C, are especially attractive because these conditions create an opportunity to combine the cycles with Gen IV reactor types (e.g., Na-cooled reactor, SCWR, or HTGR). The primary challenge in designing these cycles is to match the chemistry and energetics for achieving the highest efficiency. Active metal alloy thermochemical cycles offer the possibility of simpler process design and lower operation temperatures and, therefore, the possibility of lower capital costs. An example of these active metal alloy thermochemical cycles is the K-Bi cycle, which is particularly attractive due to simplicity and possibility to implement the process in a single-reactor setup. The K-Bi cycle consists of a thermochemical reaction (1) and an electrochemical reaction (2)