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  • ISSN: 2373-9290
    Volume 2, Issue 3
    Review Article
    Yukio Nakamura1*, Mikio Kamimura2, Shota Ikegami1, Keijiro Mukaiyama1, Shigeharu Uchiyama1 and Hiroyuki Kato1
    Abstract: Osteoporosis is a worldwide condition primarily affecting the elderly. Bone fragility fractures, such as femoral proximal fracture and vertebral fracture, that are due to osteoporosis are increasing in Japan. The measurementof bone turnover markers greatly helps in the diagnosis and assessment of osteoporosis. Here, we review the relationship between fragility fractures and bone turnover markers through recent studies, including our own.
    Research Article
    Ryogo Nakamura2, Satoshi Niwa2, Sayako Takahashi2, Etushiro Naka2 and Masahiro Tatebe1*
    Abstract: Lunate flattening was studied in 36 patients (62 wrists) with rheumatoid arthritis (RA) who were age- and gender-matched to people with normal wrists.
    The carpal height ratio (CHR) and lunate compression ratio (LCR;lunate height/lunate diameterx100, Stahl index) were measured from wrist radiographs of both groups and the lunate flattening ratio (LFR) was calculated by dividing the LCR by the CHR. The LFR reflects lunate flattening compared to carpal collapse. Twenty-four wrists underwent MRI study. T1-weighted images were evaluated for bone necrosis of the lunate. Results: the normal LFR value obtained from normal wrists ranged from 79.9 to 113.5 (meanĀ±2SD). Lunates with RA could be classified into three groups by LFR values lunates with a LFR above 113.5 (10 wrists, 16%), lunates with a LFR within the normal range (34 wrists, 55%), and lunates with a LFR lower than 79.9 (18 wrists, 29%). Twelve (50%) of the 24 wrists than underwent MRI study showed a low signal of the lunate in T1-weighted images showing osteonecrosis. Although a satisfactory correlation was not confirmed between a LFR value and a low signal on T1-weighted images, lunate avascular necrosis was suspected to play a role in flattening of the lunate.
    Irma T. Ugalde*, Halim Hennes, Lawson Copley, Rong Huang, Douglas Baker
    Abstract: Background: Discerning between early septic arthritis (SA) and transient synovitis (TS) is a challenge. Objective: Examine the relationship between secretory phopholipase A2 type IIa (SpLA2) and SA in children presenting with acute non-traumatic limp or joint pain. Methods: A prospective pilot study was conducted on a convenience sample of children presenting with acute non-traumatic limp or joint pain to a tertiary care emergency department. Clinical and laboratory data including SpLA2 levels were collected. Children were compared based on final diagnosis of SA vs. TS and the sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were determined. Results: In the 149 enrolled children, 85 were diagnosed with SA (true or presumed) or TS. The difference in median serum concentration of SpLA2 in children with SA (136,141) and TS (2,884) was statistically significant (p<0.001.) The difference in median serum concentration of SpLA2 in children with true SA (190269) and TS (2,884) was statistically significant (p<0.001.) Receiver Operator Characteristic (ROC) curve analysis revealed that SpLA2 was more accurate in predicting SA than the total white blood cell (WBC), Sedimentation rate (ESR), and C-reactive protein. An SpLA2 value of 22,658 pg/dL had a sensitivity of 88%, specificity of 88%, positive predictive value of 65%, negative predictive value of 97% and positive and negative likelihood ratios of 7.5 and 0.13, respectively. Conclusions: SpLA2 may play a role in early diagnosis of children with SA. Verification is warranted in a larger cohort.
    Leslie E Schwindel*, Vincent M Moretti, Jonathan N Watson, Mark R Hutchinson
    Abstract:
    Background: Little data exists on concussions in baseball, particularly at the professional level. The purpose of this study is to document the epidemiology of concussions in Major League Baseball (MLB) and their impact upon player performance.
    Methods: Data on MLB concussions occurring between 2001 and 2010 was gathered from disabled list records. For each player identified, additional data was gathered from online game summaries and player profiles. Recorded variables included player position, date of injury, age at time of injury, injury mechanism, and date of return to play. Performance statistics were also compiled for each player for the 15- and 30-day periods immediately after they returned to play. This included: batting average, on-base percentage, slugging percentage, earned run average, and walks plus hits per innings pitched. To serve as internal controls, identical statistics were collected from each player for the 30 days immediately prior to injury. Statistical analysis was performed using two-sided z-test for proportions with a significance level of 0.05.
    Results: 33 concussions were identified in 31 players between 2001-2010. Nine players were hit by batted balls (27.3%), 8 by pitches (24.2%) and 7 from collisions (21.2%). Nearly a third (30.3%) of injuries were to catchers. On average, players were sidelined for 32.12 days. Four players (12%) never returned at all. Slugging percentage was significantly decreased from pre-injury, but only through the first 15 days. All other statistics were showed no change from pre-concussion average through both the first 15 and 30 days after returning from injury.
    Conclusion: The recognition and reporting of concussions in MLB appears to be increasing, as we observed a near 3-fold increase in our data over the past 5 years. Catchers were at particularly high risk, representing a third of injured players. Most players returned to MLB at an average of around 30 days, but there was a 12% rate of no return. Reasons for retirement or extended disability are not known. A decrease in slugging percentage was the only statistically significant finding, with all other performance measures remaining unchanged from pre-injury values. What additional long-term impact concussions will have, especially in the setting of multiply concussed players, is unknown at this time. Based on literature from other sports, possible late-onset cognitive impairment could be expected in a small percentage of players. Long-term studies in MLB players are needed before definitive conclusions can be made. For the time being, however, knowing the incidence of concussion, risk factors specific to MLB players, and expected effects on performance can help coaches and players improve risk management and prevention.
    Editorial
    Kluczynski MA and Bisson LJ*
    Rotator cuff tears are one of the most common shoulder injuries,and often cause pain and functional limitation [1]. If non-operative treatment fails, surgical repair may be warranted. A national survey reported that 272,148 patients underwent rotator cuff repair in the United States in 2006; and the greatest rate of repair was found among patients aged 65 to 74 years (28.3 per 10,000 persons) [2].
    Middleton Gregory*
    It is widely known and accepted that osteoarthritis (OA) is very common, and occurs with increasing frequency with advancing age. Estimates from 2005 surmised that 27 million Americans suffered from clinically diagnosed osteoarthritis [1].
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