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Masashi Izumi,1 Yohei Harada,2,3 Yukihiro Kajita,2 Yoshitaka Muramatsu,2,4 Toru Morimoto,1 Yutaka Morisawa,5 Yusuke Iwahori,2,6 Masahiko Ikeuchi1 1Department of Orthopaedic Surgery, Kochi Medical School, Kochi University, Nankoku-City, Japan; 2Department of Orthopaedic Surgery, Aichi Medical University, Nagakute, Japan; 3Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; 4Department of Orthopaedic Surgery, Saiseikai Futsukaichi Hospital, Futsukaichi, Japan; 5Department of Orthopaedic Surgery, Aki General Hospital, Aki, Japan; 6Department of Orthopaedic Surgery, Sports Medicine and Joint Center, Asahi Hospital, Kasugai, JapanCorrespondence: Masashi IzumiDepartment of Orthopaedic Surgery, Kochi Medical School, Kochi University, 185-1 Kohasu, Oko-cho, Nankoku-City, Kochi Pref, 783-8505, JapanTel +81 88-880-2386Fax +81 88-880-2388Email izumim@kochi-u.ac.jpPurpose: Degenerative long head of biceps tendon (LHBT) has been recognized as a notable pain source in patients with rotator cuff tear (RCT). Tenotomy or tenodesis of LHBT is frequently indicated together with arthroscopic rotator cuff repair (ARCR) aiming for complete pain relief; however, it has not been fully investigated whether resected LHBT is really a source of pain. The purpose of this study was to investigate expression levels of pain-associated mediators in LHBT and its association with preoperative pain profiles.Methods: Twenty-seven RCT patients who underwent ARCR with LHBT resection were included. Each LHBT was resected due to its abnormal arthroscopic findings including tenosynovitis, hypertrophy, and partial tear. Worst macroscopic lesion of the LHBT was obtained, and expression levels of substance P (SP) and nerve growth factor (NGF) were evaluated using enzyme-linked immunosorbent assay (ELISA). Ten healthy knee flexor tendons were analyzed as non-degenerative samples. Preoperatively, subjective shoulder pain VAS and pain duration were investigated. Conventional LHBT pain provocation tests (Speed, Yergason, O’Brien) were performed. Pressure pain threshold (PPT) of bilateral LHBT on the groove was recorded.Results: Levels of SP and NGF expression were significantly higher compared with non-degenerative tendons (P< 0.01). Shoulder pain VAS and pain duration were not directly associated with SP and NGF expression level. Patients with positive O’Brien test expressed greater SP than negative patients (P=0.001). Significant negative correlation between the PPT ratio (ipsilateral/contralateral) and SP expression level was observed (r=− 0.453, P=0.034).Conclusion: Greater expression of SP and NGF in degenerative LHBT supported our hypothesis that it would be a pain source in RCT patients. SP was likely to be expressed highly in patients with localized pressure pain hypersensitivity and positive O’Brien test (ie, altered mechanistic pain profile of LHBT), which may help when considering simultaneous LHBT resection during ARCR.Clinical Registration: UMIN000023943.Keywords: long head of biceps tendon, pain, tendinopathy, substance P, nerve growth factor, pressure pain threshold

Background: Melanoma metastases to the CNS rank third in frequency, just after lung and breast metastases. There is controversy regarding the factors predisposing to developing CNS metastases in patients with cutaneous melanoma and their survival with conventional treatments. Methods: We carried out a retrospective analysis in a third-level hospital in Mexico to determine epidemiological aspects of melanoma metastases to the central nervous system, factors related to its appearance, clinical presentation, and survival in three treatment groups: surgery, radiotherapy, and conservative management. Results: We found that the nodular variant has the most significant association with CNS metastases. In addition, the superficial spreading variant has the highest risk of presenting a more substantial number of lesions, up to seven for each case and predominantly in the infratentorial space. On the other hand, we found more remarkable survival in patients treated only with surgery than those treated with radiotherapy or conservatively. Conclusions: This study lays the foundations for future prospective survival analysis of the different current treatment modalities for metastatic melanoma in the brain and spine. It also highlights the clinical risk factors for metastatic brain and spine tumors of melanoma.