Jacopo Preziosi Standoli

Several medical conditions (diabetes, cardiovascular diseases, hypercholesterolemia, etc) or modifiable behavioral habits (smoking habit and alcohol assumption) capable of causing damage to the peripheral microcirculation are considered potential risk factors for degeneration/tear of the rotator cuff. The aim of the study was to analyze and quantify how the association of multiple known risk factors is more effective than the predisposing action of a single factor. Three hundred eight consecutive patients who underwent arthroscopic repair of a full-thickness rotator cuff tear (RCT) represented the case group. The control group included 388 consecutive healthy asymptomatic subjects for shoulder pathologies. A multivariable prognostic model for the prediction of RCT has been performed to analyze the mutual effect of multiple risk factors. With a correct classification estimated at 70.6%, a smoker patient [odds ratio (OR) = 2.405; 95% CI = 1.645-3.516] with hypercholesterolemia (OR = 1.976; 95% CI = 1.408-2.771), diabetes (OR = 2.362; 95% CI = 1.241-4.493), and arterial hypertension (OR = 1.630; 95% CI = 1.156-2.300) has a higher chance of developing a RCT surgery compared with a peer nonsmoker healthy subject. The probability of a smoker patient suffering from hypercholesterolemia, diabetes, and arterial hypertension undergoing rotator cuff repair surgery is not given by the sum of the probabilities of each condition but increases dramatically. Each pathology interacts with each other; dramatically increasing the risk of developing a cuff tear. Level of Evidence: Level III—retrospective study.

Context: Glenohumeral internal rotation deficit (GIRD) may affect overhead athletes and contribute to shoulder injury. Objectives: To assess data on passive shoulder range of motion (ROM) in young elite swimmers and to determine the prevalence of anatomical and pure GIRD (aGIRD and pGIRD, respectively) in a large sample size of asymptomatic elite swimmers with a new classification method. Design: Cross-sectional study. Setting: Research laboratory. Patients or Other Participants: A total of 752 asymptomatic elite swimmers were recruited by voluntary participation (391 males and 361 females; mean age, 15.88 ± 2.31 years). Passive glenohumeral rotational ROM was measured bilaterally to investigate the prevalence of aGIRD and pGIRD. Evaluations were performed with athletes at rest before any training or competition. Main Outcome Measure(s): Glenohumeral internal rotation deficit and associated aGIRD and pGIRD in elite youth swimmers by identifying a standard classification procedure. Results: Glenohumeral internal rotation deficits were found in 136 participants (18.1%). Anatomical GIRD was present in 28 cases (3.7%), whereas pGIRD was observed in 108 cases (14.4%). No significant differences were found regarding GIRD between sex, age, age group, years of training, breathing side, and distance. Swimmers with pGIRD showed significantly less dominant internal rotation, total ROM, and external rotation gain (P < .01) than swimmers with aGIRD; conversely, swimmers with aGIRD showed significantly less nondominant internal rotation, external rotation, and total ROM than swimmers with pGIRD (P < .01). Conclusion: Glenohumeral internal rotation deficit is a relatively common condition in asymptomatic elite youth swimmers; as to not overestimate this condition, aGIRD and pGIRD have to be distinguished. Although they play a role, the respiratory side, dominant limb, and crawl did not have a significant impact on an elite swimmer with GIRD.

Variable epidemiological data are known on medial clavicle fractures (MCFs). To obtain demographic information regarding the etiopathogenesis of MCFs. All fractures were radiographically evaluated. Age; gender; side; date of fracture; fragment dislocation; associated fractures; fracture mechanism were collected. Three age groups were distinguished. 1096 patients were enrolled: 29 (2.6%) had an MCF. Nineteen (66%) were males; mean age was 51.6 years (SD±24.4; range: 18-87). The right side was involved in 19 cases (66%). Nineteen fractures (66%) were un-displaced. Five patients (16.6%) had associated fractures. Accidental falls represent the main cause of fracture. In advanced age (Group III), simple fall was the only cause of fracture. On the occasion of a fall, the right side was significantly more involved (p <0.05). Sports injuries were responsible for 22.2% of fractures, but for 42.9% of fractures in younger patients (Group I). Traffic accidents were responsible for five fractures (16.7%). During the sunny seasons, the highest number of fractures occurred; the vast majority of fractures (83.3%) occurred on working days (p <0.05). Medial clavicle fractures represent 2.6% of all clavicle fractures. Middle-aged males and the right side are more involved. Two-thirds of fractures are un-displaced. Accidental falls represent the main cause of fracture. During sunny seasons, the highest number of fractures occurred.

Little is known regarding the optimal timing of dysphagia assessment and PEG indication in amyotrophic lateral sclerosis (ALS). The study aims to investigate the progression of dysphagia in a cohort of ALS patients and to analyse whether there are variables linked to a faster progression of dysphagia and faster indication of PEG placement. A retrospective cohort study in 108 individuals with ALS. Fiberoptic endoscopic evaluation of swallowing was performed 6 monthly until PEG indication or death. Dysphagia severity and PEG indication were assessed using Penetration Aspiration Scale. Progression Index (PI) analysed the risk of disease progression (fast/slow) in relation to dysphagia onset and PEG indication. Patients were grouped based on ALS onset and PI. Person-time incidence rates were computed considering dysphagia onset and PEG indication from ALS symptoms during the entire observation period and have been reported as monthly and 6-month rates. Cox regression survival analysis assessed dysphagia and PEG risk factors depending on onset. Person-time incidence rates of dysphagia progression and PEG risk were increased based on type of ALS onset and PI. Patients with a fast progressing disease and with bulbar onset (BO) show statistically significant increased risk of dysphagia (BO 178.10% hazard ratio (HR) = 2.781 P < 0.01; fast 181.10% HR 2.811 P < 0.01). Regarding PEG risk, fast patients and patients with BO had a statistically significant increased risk (fast 147.40% HR 2.474 P < 0.01, BO 165.40% HR 2.654 P < 0.01). Fast PI predicts the likelihood of faster progression of dysphagia and PEG indication and should be included in multidisciplinary assessments and considered in the design of future guidelines regarding dysphagia management in ALS patients.Level of Evidence Level IV.

Evidence suggests that physical activity (PA) influences the human gut microbiota composition, but its role is unclear because of dietary interference. The aim of this review is to clarify this issue from this new perspective in healthy individuals. Articles analyzing intestinal microbiota from fecal samples by 16S rRNA amplicon sequencing were selected by searching the electronic databases PubMed, Scopus, and Web of Science until December 2020. For each study, methodological quality was assessed, and results about microbiota biodiversity indices, phylum and genus composition, and information on PA and diet were considered. From 997 potentially relevant articles, 10 met the inclusion criteria and were analyzed. Five studies involved athletes, three were performed on active people classified on the basis of habitual PA level, and two among sedentary subjects undergoing exercise interventions. The majority of the studies reported higher variability and prevalence of the phylum Firmicutes (genera Ruminococcaceae or Fecalibacteria) in active compared to inactive individuals, especially in athletes. The assessment of diet as a possible confounder of PA/exercise effects was completed only in four studies. They reported a similar abundance of Lachnospiraceae, Paraprevotellaceae, Ruminococcaceae, and Veillonellaceae, which are involved in metabolic, protective, structural, and histological functions. Further studies are needed to confirm these findings.

Purpose The anatomy of the articular surfaces has historically identified as major responsible for acromioclavicular joint osteoarthritis (ACJO). On the other side, the almost 100% prevalence of ACJO in subjects over 50 years old seems to suggest a multifactorial etiology. We compared ACJO between asymptomatic elderly monozygotic (MZ) and dizygotic (DZ) twins to investigate the influence of genetics and environmental factors. Materials and Methods Thirty pairs of twins [15MZ-15DZ; mean age (SD): 63.70 (3.31); range: 53-72] were retrospectively enrolled. ACJO was evaluated on MRI through a 4-grade severity scale and ACJ configuration was assessed. Information regarding work activity were obtained. Heritability index was calculated. Results The intraclass correlation coefficient (ICC) value of 0.868 (95% CI; 0.798 to 0.917). An ICC values of 0.889 (95% CI; 0.798 to 0.944) and 0.843 (95% CI, 0.712 to 0.920) were found in the MZ and DZ groups, respectively. The polychoric correlation was 0.857 in the MZ twins and 0.757 in the DZ twins. The calculated heritability index was 0.20 (20%), and the contribution of the shared environment (c2) and unique environment (e2) was 0.66 (66%) and 0.14 (14%), respectively. No relationship between job types and ACJO in both the total cohort (r = 0.089;p = 0.499) and in the monozygotic (r = 0.247;p = 0.187) and the dizygotic twin groups (r = -0.084;p = 0.658) was found. Conclusions The role of genetics on ACJO accounts for only 20%; a specific anatomical configuration of the articular surfaces only partially acts on the development of joint osteoarthritis. Environmental factors have the greatest impact.

Background: Gut microbiota development and composition can be influenced by an existing dynamic balance between host physiology and lifestyle. This systematic review aims to assess the impact of physical activity on human gut microbiota. Methods: PubMed, Scopus and Web of Science were searched until May 2019. Full-text in English were recruited if focused on gut microbiota in healthy athletes or active people, without age or gender restrictions, collected on faecal samples and analysed with genome sequencing of rRNA 16S. All types of study design were included as long as they performed a comparison with a sedentary control group. No specific time frame for the publication date was applied. Quality assessment was performed using the JBI Critical Appraisal Checklist for Analytical Cross Sectional Studies (2017) and Cochrane Risk of Bias Tool for Randomized Controlled Trials. Results: The analysis yielded 7/985 articles: five cross-sectional studies and two clinical trials, published from 2014 to 2019. The overall methodological assessment was of fair quality. Types of exercise included in the studies were: rugby, running, aerobic exercise, bodybuilding. More in detail, regarding the exercise load, some studies were conducted on elite professional athletes, such as rugby players, marathon runners or bodybuilders, with rigorous training, while other studies included a few weeks of aerobic and resistance training at a moderate intensity. Shannon diversity index increased in three studies. Concerning phyla, Firmicutes were increased in five studies and three studies described a significant decrease in Bacteroides. Conclusions: This systematic review confirms the direct correlation between microbiota composition and physical activity, but further studies are needed to establish the possible presence of a causal link between the two factors. Key messages: Exercise can play an important role as an environmental factor in determining gut microbiota composition. Further studies are needed to gain robust evidence of physical activity influence on gut microbiota variability.