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Subscapularis (SSC) tendon tears are less common than tears of the remaining rotator cuff tendons, but one with serious consequences given its function as one of the main internal rotators and anterior stabilizers. Mild fraying involving the upper third of the tendon can be treated non-operatively; however, more substantive tears usually require repair in cases of pain or functional impairment. Given the importance of the subscapularis tendon in maintaining stability of the glenohumeral joint and performing internal rotation of the arm, surgical intervention with emphasis on repair may be recommended to eliminate pain and restore strength. Postoperative rehabilitation through phased progression is utilized to avoid premature stress on the healing tissue while enabling early return to daily activities. The purpose of this clinical commentary is to provide an evidence-based description of postoperative rehabilitation following SSC tendon repair with guidance for safe and effective return to activity and sports. Level of evidence 5.

“We are planning to increase our engagement in the area of 3D printing and are looking for someone to lead this effort. Would you be interested in this position?” I was asked this question by Bonnie Fetch, a woman I admired and someone who would eventually be my mentor, my advocate, and my manager. Bonnie was a director at my employer where I had worked for the past 25 years and I had no idea how to respond. I had no background in 3D printing. I was just coming off a special assignment, having spent the previous year serving as the president of the Society of Women Engineers at a global level. It was time to get back into a more traditional role at work. Despite having no experience in 3D printing, I did have 25 years of component product development experience in engineering and manufacturing coupled with 15 years of engineering leadership. I had no idea if 3D printing was an area I wanted to pursue. Spoiler alert; I accepted the job. But my experience leading up to this point, what I did in this role, and what I did after the role are the subject of this chapter.

International audience; Background and purpose - Up-to-date information is needed on the extent to which neurologists treating multiple sclerosis (MS) in Europe are integrating rapidly evolving diagnostic criteria, disease-modifying therapies and recommendations for monitoring disease activity into their clinical practice. Methods - A steering committee of MS neurologists used a modified Delphi process to develop case- and practice-based questions for two sequential surveys distributed to MS neurologists throughout Europe. Case-based questions were developed for radiologically isolated syndrome (RIS), clinically isolated syndrome (CIS), relapsing-remitting MS (RRMS) and RRMS with breakthrough disease. Results - Multiple sclerosis neurologists from 11 European countries responded to survey 1 (n = 233) and survey 2 (n = 171). Respondents agreed that they would not treat the patients in the RIS or CIS cases but would treat a patient with a relatively mild form of RRMS. Choice of treatment was evenly distributed among first-line injectables and oral treatments for mild RRMS, and moved to second-line treatment as the RRMS case increased in severity. Additional results on RRMS with breakthrough disease are presented. Conclusions - Although there was general agreement on some aspects of treatment, responses to other management and clinical practice questions varied considerably. These results, which reflect current clinical practice patterns, highlight the need for additional MS treatment education and awareness and may help inform the development of MS practice guidelines in Europe.

Background.Surveillance represents a key strategy to control type 1 diabetes mellitus (T1DM). In Italy, national data are missing. This study aimed at evaluating the incidence of T1DM in subjects Methods.We performed a retrospective study matching records from regional Hospital Discharge Registry (HDR), User Fee Exempt Registry (UFER), and Drugs Prescription Registry (DPR) and calculated T1DM incidence; completeness of each data source was also estimated. In order to assess the RCOD sensitivity we compared cases from the registry to those extracted from HDR-UFER-DPR matching.Results.During 2009–2013, a total of 917 cases (about 184/year) in at least one of the three sources and an annual incidence of 25.2 per 100,000 were recorded, lower in infant, increasing with age and peaked in 5- to 9-year-olds. The completeness of DPR was 78.7%, higher than that of UFER (64.3%) and of HDR (59.6%). The RCOD’s sensitivity was 39.05% (360/922; 95% CI: 34.01%–44.09%).Conclusions.Apulia appeared as a high-incidence region. A full, active involvement of physicians working in paediatric diabetes clinics would be desirable to improve the RCOD performance.

The authors of this chapter review the anatomy, classification, indications, imaging, surgical techniques, complications and post-operative rehabilitation of distal clavicle fractures. Advanced arthroscopic techniques and open reduction internal fixation (ORIF) are discussed for high-risk young athletes.

Superior capsule reconstruction is a recently-developed surgical technique for the treatment of massive, irreparable rotator cuff tears. So far, biomechanical cadaveric studies and clinical outcomes results have been promising concerning integrity, stability, and ROM after superior capsule reconstruction. As this technique has only been recently developed, an evidence-based rehabilitation protocol has not been previously designed. Thus, the purpose of this clinical commentary is to provide an overview of superior capsule reconstruction and to propose a rehabilitation program based on the available scientific evidence. The existing evidence is supplemented by the experience of the senior author who has performed more than forty superior capsule reconstruction procedures to date. This proposed rehabilitation protocol consists of four distinct phases, focusing on maximal protection, range of motion and muscular endurance, muscular strength and return to activity.5.

Background and purpose The European Charcot Foundation supported the development of a set of surveys to understand current practice patterns for the diagnosis and management of multiple sclerosis (MS) in Europe. Part 2 of the report summarizes survey results related to secondary progressive MS (SPMS), primary progressive MS (PPMS), pregnancy, paediatric MS and overall patient management. Methods A steering committee of MS neurologists developed case- and practice-based questions for two sequential surveys distributed to MS neurologists throughout Europe. Results Respondents generally favoured changing rather than stopping disease-modifying treatment (DMT) in patients transitioning from relapsing-remitting MS to SPMS, particularly with active disease. Respondents would not initiate DMT in patients with typical PPMS symptoms, although the presence of ≥1 spinal cord or brain gadolinium-enhancing lesion might affect that decision. For patients considering pregnancy, respondents were equally divided on whether to stop treatment before or after conception. Respondents strongly favoured starting DMT in paediatric MS with active disease; recommended treatments included interferon, glatiramer acetate and, in John Cunningham virus negative patients, natalizumab. Additional results regarding practice-based questions and management are summarized. Conclusions Results of part 2 of the survey of diagnostic and treatment practices for MS in Europe largely mirror results for part 1, with neurologists in general agreement about the treatment and management of SPMS, PPMS, pregnancy and paediatric MS as well as the general management of MS. However, there are also many areas of disagreement, indicating the need for evidence-based recommendations and/or guidelines.

We explore relationships linking clinical symptoms, respiratory dysfunction, and local production of proinflammatory chemokines in the pneumonia virus of mice (PVM) model of viral bronchiolitis. With a reduced inoculum of this natural rodent pathogen, we observe virus clearance by day 9, while clinical symptoms and respiratory dysfunction persist through days 14 and 17 postinoculation, respectively. Via microarray and ELISA, we identify expression profiles of proinflammatory mediators MIP-1alpha, MCP-1, and MIP-2 that correlate with persistent respiratory dysfunction. MIP-1alpha is localized in bronchial epithelium, which is also the major site of PVM replication. Interferon-gamma was detected in lung tissue, but at levels that do not correlate with respiratory dysfunction. Taken together, we present a modification of our pneumovirus infection model that results in improved survival and data that stand in support of a connection between local production of specific mediators and persistent respiratory dysfunction in the setting of acute viral bronchiolitis.

Cystic parathyroid lesions (CPL) account for 1–5% of neck cysts. They are seldom palpable; however, they may present as neck swellings that are mistaken both clinically and cytologically for thyroid nodules and subsequently referred for evaluation by fine-needle aspiration. We present 4 cases of histologically confirmed CPL (one simple cyst, one hyperplasia, and two adenomas), 2 of which were misdiagnosed as adenomatoid thyroid nodules by fine-needle aspiration. Aspirated fluid from one patient was clear and colorless, a classic finding for parathyroid cysts, and contained high levels of C-terminal/midmolecule parathyroid hormone (CMPH). Fluids obtained from the remaining 3 patients were bloody to brown, resembling thyroid cyst fluid. In only 1 of the 3 patients, the fluid was analyzed and contained high levels of CMPH. Though cytologic features of parathyroid epithelium overlap with those of thyroid epithelium, distinguishing features such as unusual cytoplasmic vacuolization and granularity, and the absence of colloid, should raise suspicions of a parathyroid lesion. Fluid from CPL may not possess the classic appearance; however, identification of the subtler cytologic features with knowledge of relevant clinical data should prompt analysis of cyst fluid for CMPH, thus confirming the diagnosis and avoiding inappropriate therapy. Diagn Cytopathol 1996;15:306–311. © 1996 Wiley-Liss, Inc.

Temporary conical strainers are widely employed in the Oil & Gas industry as filtering devices in the Centrifugal Compressors suction line. They protect compressor stages from the ingestion of foreign objects whether coming from dirty process gas or left in the pipeline after its construction. Very few literature and research papers are available on the fluid dynamic and structural performance of conical strainers. The purpose of this work is to plug this gap by the definition of a theoretical-experimental model for the characterization of the pressure drop and mechanical resistance of these devices. Starting from the definition of the main fluid dynamics and geometric variables which influence the performances, an experimental campaign has been performed in order to derive the relationship governing the pressure drop behavior. The model efficacy has been confirmed by a CFD analysis, which also allowed a qualitative insight review into the dynamics of velocity and turbulence intensity fields. Further tests have been performed in order to validate the model at off-design points. As far as the structural analysis is concerned, several FEM models and DOE techniques have been implemented in order to define relationships for bust pressure computation and feasible design improvements with respect to the current state of the art. Besides fluid dynamic and structural correlations, the notable achievements of this work are the definition of best pressure static probes positioning and the maximum clogging level that a strainer can withstand before collapse. Furthermore, some guidelines are given in order to prevent pipeline resonance and acoustic fatigue caused by the interaction between strainer turbulence and compressor inlet flow.Copyright © 2012 by ASME

The research described in this paper extended a deterministic screening model for ground‐water contamination to include specification of variability in water flux and soil and chemical properties. Uncertainty in these parameters was characterized by independent log‐normal probability distributions and a Monte Carlo simulation process was used to estimate the expected percentages of chemical mass reaching the water table. These Monte Carlo results were compared with a deterministic analysis that ignored hydrologic and soil spatial variability. For many of the 49 chemicals analyzed in this study, the Monte Carlo results produced substantially higher estimates of groundwater contamination than the deterministic analyses, indicating that neglecting hydrologic and soil spatial uncertainty may underestimate the potential for pollution. However, for those chemicals and site conditions most likely to produce major contamination, the Monte Carlo and deterministic analyses produced comparable results.

Rosai-Dorfman disease (also known as sinus histiocytosis with massive lymphadenopathy) is a rare disease of unknown etiology that typically presents as nodal disease in young children. However, it also can present in various extranodal sites and can be difficult to recognize if not considered in the differential diagnosis. We describe a 55-year-old man who was discovered to have extranodal Rosai-Dorfman disease that presented as a cardiac mass involving the left atrium and ventricle during evaluation for atypical chest pain, and discuss the clinical, radiologic, and pathologic findings as well as treatment approach and consideration of a possible relationship of this entity to IgG4-related sclerosing lesions.

The aim of this study was to evaluate the toxicity and efficacy of a monochemotherapy regimen of dacarbazine (DTIC), tamoxifen , interferon-alpha2a and interleukin-2 (IL-2) and two polychemotherapy regimens of cisplatin, DTIC, vindesine, tamoxifen, interferon-alpha2a with or without IL-2 in patients with metastatic melanoma. Consecutive patients with metastatic melanoma were enrolled in this trial and were randomized to arm A, consisting of DTIC 800 mg/m2 every 21 days, IL-2 9 MIU subcutaneously days 1-5 and 8-12, arm B, consisting of cisplatin 30 mg/m2 days 1-3, DTIC 250 mg/m2 days 1-3 and vindesine 2.5 mg/m2 day 1 every 28 days (CVD), or arm C, consisting of CVD plus IL-2 6 MIU days 1-5 and 8-12 every 28 days. In all three arms Interferon 3 MU subcutaneously three times a week and tamoxifen 20 mg orally were given throughout. Ninety-two patients were included in this study. Patient characteristics in the three groups were well balanced. The three regimens were delivered on an outpatient basis without major toxicity. The toxicities that did occur consisted primarily of flu-like symptoms in the IL-2 arms (A and C) and haematological toxicities in the CVD arms (B and C). No grade IV toxicities were encountered and no treatment-related deaths occurred. The total response rate was 13% in arm A, 35% in arm B and 37% in arm C. The median duration of response was 6 months and the median survival was 11 months. According to this phase II randomized trial polychemoimmunotherapy with CVD has an objective response rate of 35-36%, while monochemoimmunotherapy with DTIC has a response rate of 13%.

Cystic parathyroid lesions (CPL) account for 1-5% of neck cysts. They are seldom palpable; however, they may present as neck swellings that are mistaken both clinically and cytologically for thyroid nodules and subsequently referred for evaluation by fine-needle aspiration. We present 4 cases of histologically confirmed CPL (one simple cyst, one hyperplasia, and two adenomas), 2 of which were misdiagnosed as adenomatoid thyroid nodules by fine-needle aspiration. Aspirated fluid from one patient was clear and colorless, a classic finding for parathyroid cysts, and contained high levels of C-terminal/midmolecule parathyroid hormone (CMPH). Fluids obtained from the remaining 3 patients were bloody to brown, resembling thyroid cyst fluid. In only 1 of the 3 patients, the fluid was analyzed and contained high levels of CMPH. Though cytologic features of parathyroid epithelium overlap with those of thyroid epithelium, distinguishing features such as unusual cytoplasmic vacuolization and granularity, and the absence of colloid, should raise suspicions of a parathyroid lesion. Fluid from CPL may not possess the classic appearance; however, identification of the subtler cytologic features with knowledge of relevant clinical data should prompt analysis of cyst fluid for CMPH, thus confirming the diagnosis and avoiding inappropriate therapy.

Systemic chemotherapy with currently available agents in unresectable HCC has a minimal impact on disease progression and a predictable response rate of

We have searched for the $\ensuremath{\beta}$-decay branch from the $^{42}\mathrm{Sc}$ ground state to the 1.837 MeV level in $^{42}\mathrm{Ca}$. Since both states are ${J}^{\ensuremath{\pi}}={0}^{+}$, $T=1$, this decay is an example of a non-analog Fermi decay which could occur by reason of some mixing of the analog ground states into the lowest excited ${\mathrm{O}}^{+}$ state in both $^{42}\mathrm{Sc}$ and $^{42}\mathrm{Ca}$. As a signal for this branch, we looked for a subsequent cascade $\ensuremath{\gamma}$ ray with a Ge(Li) detector-rabbit arrangement. We found a branching ratio of (2.2 \ifmmode\pm\else\textpm\fi{} 1.7) \ifmmode\times\else\texttimes\fi{} ${10}^{\ensuremath{-}5}$ relative to the superallowed ground state to ground state decay. Interpreted as an upper limit, this corresponds to a branching ratio 3.9 \ifmmode\times\else\texttimes\fi{} ${10}^{\ensuremath{-}5}$ at the 84% confidence level. This result is at the lower bound of what present theory can predict with a Coulomb force mixing calculation.

Closely related high spin states in /sup 206/Bi, /sup 208/Bi, and /sup 210/Bi are preferentially excited in the /sup 204/ /sup 206/ /sup 208/Pb(..cap alpha..,d) reaction at 48 MeV. The character of these states can be understood from the selectivity of the (..cap alpha..,d) transfer mechanism and experimental systematics. Microscopic distorted-wave Born approximation predictions are consistent with new J/sup ..pi../ assignments for 14 strongly excited states with 9 or = 11). This shortcoming is not overcome by full finite range calculations. The strong population of 10/sup -/, 11/sup +/, 12/sup +/, and 14/sup -/ states involves the largest L transfers in direct reactions observed to date.

The $^{54}\mathrm{Fe}(d,\ensuremath{\alpha})^{52}\mathrm{Mn}$ reaction was studied at 17-MeV bombarding energy. Energy assignments based on the ($d,\ensuremath{\alpha}$) and two ($^{3}\mathrm{He}$, $t$) spectra were made for some 60 levels up to about 4 MeV of excitation in $^{52}\mathrm{Mn}$ with accuracies ranging from \ifmmode\pm\else\textpm\fi{} 1 to \ifmmode\pm\else\textpm\fi{} 10 keV. $(d,\ensuremath{\alpha})L$-transfer assignments or suggestions were made for 28 of these levels based on a recent distorted-wave Born-approximation procedure. Spin-parity limits based on the ($d,\ensuremath{\alpha}$) analysis are generally in agreement with other work although a few discrepancies are noted. The $^{52}\mathrm{Cr}(p,n\ensuremath{\gamma})^{52}\mathrm{Mn}$ coincidence experiment was performed at bombarding energies of 8.0, 8.5, 9.0, 9.5, and 10.0 MeV. $30\ensuremath{\gamma}$ rays were fitted into a decay scheme which includes four previously un-reported levels below 1.3 MeV of excitation in $^{52}\mathrm{Mn}$. Two of these new levels were weakly excited in ($d,\ensuremath{\alpha}$), while the other two appeared as an unresolved group in the ($^{3}\mathrm{He}$, $t$) spectra. Since the $\ensuremath{\gamma}$-rays were observed with 3-keV Ge(Li) detector resolution, accurate energy assignments (\ensuremath{\le}\ifmmode\pm\else\textpm\fi{}0.5 keV) could be made for 14 levels in $^{52}\mathrm{Mn}$. The $\ensuremath{\gamma}$-ray data are consistent with the ($d,\ensuremath{\alpha}$) spin limits. A comparison of the low-lying states with the McCullen, Bayman, and Zamick calculations is presented. The four new levels do not fit into the pure ${f}_{\frac{7}{2}}$-shell scheme.

Levels of ${\mathrm{Co}}^{56}$ up to 2.6 MeV of excitation have been studied by ${\mathrm{Fe}}^{56}(p,n\ensuremath{\gamma})$ coincidence experiments. $\ensuremath{\gamma}$ rays were detected with a 40-${\mathrm{cm}}^{3}$ coaxial Ge(Li) detector. Neutrons were detected with a ${1000\ensuremath{-}\mathrm{c}\mathrm{m}}^{3}$ liquid scintillation counter. Pulse-shape discrimination was used to distinguish neutrons from the $\ensuremath{\gamma}$-ray contamination in the neutron detector. Energy and time-of-flight information was stored for each coincident event on magnetic tape with 1024\ifmmode\times\else\texttimes\fi{}256-channel resolution. Gated one-dimensional $\ensuremath{\gamma}$ spectra were also taken with 4096-channel resolution in order to obtain accurate energies (\ifmmode\pm\else\textpm\fi{}0.5 keV). Proton beam energies of 7.7, 8.1, 8.5, 9.5, and 10 MeV were used to determine the approximate threshold for the appearance of the individual $\ensuremath{\gamma}$ rays. 21 ${\mathrm{Co}}^{56}$ $\ensuremath{\gamma}$ rays were identified. The decay scheme constructed is consistent with the known information on this nucleus and supports a number of spin assignments recently suggested by Schneider and Daehnick. The experimental procedure is discussed in some detail.

In the case of angular-momentum-mismatch conventional distorted-wave Born-approximation (DWBA) calculations tend to give results which are strongly dependent on the opticalmodel parameters chosen and, to a lesser degree, on finite-range and nonlocality effects. We discuss reasons for this sensitivity and present systematic calculations for ($d,\ensuremath{\alpha}$) reactions on nondeformed targets ranging from $^{48}\mathrm{Ti}$ to $^{208}\mathrm{Pb}$. Satisfactory DWBA results could be obtained for the entire range of targets, provided that all potentials for the generation of scattered and bound wave functions were restrained to have nearly identical physically meaningful real well geometries and real depths of $V\ensuremath{\approx}n{V}_{0}$, where ${V}_{0}$ is the proton scattering potential and $n$ is the number of nucleons in the projectile. The use of well geometries with ${r}_{0}=1.2$ fm, $a=0.75$ fm, and retention of the basic DWBA requirement that the optical potentials should also correctly fit elastic scattering removes the familiar ambiguities for deuteron and $\ensuremath{\alpha}$ potentials. It is shown that with these parameter restrictions finite range effects are expected to be small so that a first-order correction procedure is adequate. Explicit calculations are compared with over 30 ($d,\ensuremath{\alpha}$) angular distributions of known angular momentum transfer for experimental bombarding energies ranging from 12 to 17 MeV. Consistent agreement with experiment was obtained.

A transformer utilizing a rotating flux for saturating the entire core. The transformer uses a core configured such that a vector sum of the induction produced by two windings in the core rotates through 360°. This is accomplished by arranging the component induction vectors to be perpendicular and the source voltages associated with each of the component induction vectors to be 90° out of phase. If the inductions are of equal magnitude and the vector sum is sufficient to saturate the core, rotation of the vector sum saturates the entire core and the transformer experiences a very low or nearly negligible hysteresis losses. Various topological configurations for the core, including a toroid, are described. The transformer windings can be arranged for single, two-phase, three-phase, or multi-phase operation.

The aim of this study was to evaluate the toxicity and efficacy of a monochemotherapy regimen of dacarbazine (DTIC), tamoxifen , interferon-alpha2a and interleukin-2 (IL-2) and two polychemotherapy regimens of cisplatin, DTIC, vindesine, tamoxifen, interferon-alpha2a with or without IL-2 in patients with metastatic melanoma. Consecutive patients with metastatic melanoma were enrolled in this trial and were randomized to arm A, consisting of DTIC 800 mg/m2 every 21 days, IL-2 9 MIU subcutaneously days 1-5 and 8-12, arm B, consisting of cisplatin 30 mg/m2 days 1-3, DTIC 250 mg/m2 days 1-3 and vindesine 2.5 mg/m2 day 1 every 28 days (CVD), or arm C, consisting of CVD plus IL-2 6 MIU days 1-5 and 8-12 every 28 days. In all three arms Interferon 3 MU subcutaneously three times a week and tamoxifen 20 mg orally were given throughout. Ninety-two patients were included in this study. Patient characteristics in the three groups were well balanced. The three regimens were delivered on an outpatient basis without major toxicity. The toxicities that did occur consisted primarily of flu-like symptoms in the IL-2 arms (A and C) and haematological toxicities in the CVD arms (B and C). No grade IV toxicities were encountered and no treatment-related deaths occurred. The total response rate was 13% in arm A, 35% in arm B and 37% in arm C. The median duration of response was 6 months and the median survival was 11 months. According to this phase II randomized trial polychemoimmunotherapy with CVD has an objective response rate of 35-36%, while monochemoimmunotherapy with DTIC has a response rate of 13%.

The $Q$ value for the reaction $^{204}\mathrm{Pb}(\ensuremath{\alpha},d)^{206}\mathrm{Bi}$ has been measured as ${Q}_{0}=\ensuremath{-}15798\ifmmode\pm\else\textpm\fi{}11.6$ keV. This leads to a $^{206}\mathrm{Bi}$ mass excess of -20 019 \ifmmode\pm\else\textpm\fi{} 13 keV which differs by 107 keV from the previously accepted value. Previously adopted mass values for $^{210}\mathrm{At}$, $^{214}\mathrm{Fr}$, $^{218}\mathrm{Ac}$, and $^{222}\mathrm{Pa}$ are also directly affected by a change in the $^{206}\mathrm{Bi}$ mass.