Return-to-Play Rates and Clinical Outcomes of Baseball Players After Concomitant Ulnar Collateral Ligament Reconstruction and Selective Ulnar Nerve Transposition

Background:

Injury to the ulnar collateral ligament (UCL) leading to medial elbow instability and possible ulnar neuritis is common in overhead-throwing athletes. Treatment may require UCL reconstruction (UCLR) and concomitant ulnar nerve transposition (UNT) for those with preoperative ulnar neuritis.

Purpose:

To evaluate the return-to-play (RTP) rates, clinical outcomes, and rates of persistent ulnar neuritis after concomitant UCLR and UNT in a cohort of baseball players with confirmed preoperative ulnar neuritis.

Study Design:

Case series; Level of evidence, 4.

Methods:

Eligible patients were those who underwent concomitant UCLR and UNT at a single institution between January 2008 and June 2018 and who had a minimum of 2 years of follow-up. Additional inclusion criteria were athletes who identified as baseball players and who had a confirmed history of ulnar neuritis. Patients were contacted at a minimum of 2 years from surgery and assessed with the Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow Score, Andrew-Timmerman (A-T) Elbow Score, Mayo Elbow Performance Score (MEPS), Single Assessment Numeric Evaluation (SANE) score, and a custom RTP questionnaire.

Results:

Included were 22 male baseball players with a mean age of 18.9 ± 2.1 years (range, 16-25 years). The mean follow-up was 6.1 ± 2.4 years (range, 2.5-11.7 years). Preoperatively, all 22 patients reported ulnar nerve sensory symptoms, while 4 (18.2%) patients reported ulnar nerve motor symptoms. At the final follow-up, 7 (31.8%) patients reported persistent ulnar nerve sensory symptoms, while none of the patients reported persistent ulnar nerve motor symptoms. Overall, 16 (72.7%) players were able to return to competitive play at an average of 11.2 months. The mean postoperative patient-reported outcome scores for the KJOC Shoulder and Elbow Score, MEPS, A-T Elbow Score, and SANE score were 77.9 ± 20.9 (range, 14-100), 92.7 ± 12.7 (range, 45-100), 86.1 ± 17.1 (range, 30-100), and 85.5 ± 14.8 (range, 50-100), respectively.

Conclusion:

This study demonstrated that after concomitant UCLR and UNT for UCL insufficiency and associated ulnar neuritis, baseball players can expect reasonably high RTP rates and subjective outcomes; however, rates of persistent sensory ulnar neuritis can be as high as 30%.

Fluorescence correlation spectroscopy to unravel the interactions between macromolecules in wine

In this work, the interaction of wine macromolecules with a bovine serum albumin (BSA) was investigated using fluorescence correlation spectroscopy (FCS). FCS offers the opportunity to study molecular and macromolecular aggregation without disturbing the wine by introducing only very small amounts of fluorescently labelled molecules to the system. It was observed that the diffusion coefficient of fluorescently labelled BSA varies with the addition of wine macromolecules, indicating changes in the protein conformation and the formation of complexes and aggregates. The addition of a wine polysaccharide rhamnogalacturonan II-enriched fraction led to aggregation, while addition of a mannoprotein-enriched fraction exhibited a protective effect on protein aggregation. Proteins strongly interacted with tannins, leading to the precipitation of protein-tannin complexes, while the presence of polysaccharides prevented this precipitation. Finally, the application of FCS was demonstrated in real wines, to investigate the problem of protein haze formation through live monitoring of heat-induced aggregation in wine.

White wine taste and mouthfeel as affected by juice extraction and processing

The juice used to make white wine can be extracted using various physical processes that affect the amount and timing of contact of juice with skins. The influence of juice extraction processes on the mouthfeel and taste of white wine and their relationship to wine composition were determined. The amount and type of interaction of juice with skins affected both wine total phenolic concentration and phenolic composition. Wine pH strongly influenced perceived viscosity, astringency/drying, and acidity. Despite a 5-fold variation in total phenolics among wines, differences in bitter taste were small. Perceived viscosity was associated with higher phenolics but was not associated with either glycerol or polysaccharide concentration. Bitterness may be reduced by using juice extraction and handling processes that minimize phenolic concentration, but lowering phenolic concentration may also result in wines of lower perceived viscosity.

Odor detection thresholds and enantiomeric distributions of several 4-alkyl substituted gamma-lactones in Australian red wine

The individual enantiomers of gamma-octalactone (1), gamma-nonalactone (2), gamma-decalactone (3) and gamma-dodecalactone (4) have been synthesized. The (R) series of enantiomers was prepared from L-glutamic acid by a strategy involving deamination and reduction to (S)-5-oxo-2-tetrahydrofurancarboxaldehyde (S)-7. The different length side chains were introduced by a series of Wittig reactions, varying in the choice of phosphorane used. Hydrogenation then gave the final gamma-lactones 1-4. The (S) series of enantiomers was prepared in an analogous fashion beginning with d-glutamic acid. Aroma detection thresholds for all eight enantiomers were determined in a "bag in a box" dry red wine by the application of ASTM method E 679, employing a panel of 25 members. The lowest threshold determined was 8 microg/L for (R)-dodecalactone (4) while the highest threshold was 285 microg/L for (R)-nonalactone (2). With the exception of gamma-decalactone (3) there were statistically significant differences (at the 5% level) in aroma detection thresholds between the two enantiomers of the same lactone. A stable isotope method developed for quantification of the lactones 1-4 has been extended for use with chiral phase GC (Rt-betaDEXcst capillary column) allowing quantification of the individual enantiomers. The enantiomeric distribution of gamma-octalactone (1) and gamma-nonalactone (2) in seven botrytized wines and of 2 in a total of 34 red wines were thus determined; with few exceptions, the (R) enantiomer of gamma-nonalactone (2) was found to be more prevalent than its (S) counterpart in the dry red and botrytized white wines analyzed. The same was true for gamma-octalactone (1) in the botrytized white wines.

Statistical correlations between the in-mouth textural characteristics and the chemical composition of Shiraz wines

The relationships between the levels of polyphenols, acidity, and red pigments in Shiraz wines and their perceived textural profiles as quantified by a trained sensory descriptive analysis panel were explored. A "chamois-like" feeling when the wine was held in the mouth appeared to be related to an absence of polyphenols. The in-mouth "chalk-like" texture was strongly associated with anthocyanin concentration and was negatively associated with alcohol level and acidity. The astringent subqualities of "velvet-like" and "emery-like" roughing were mostly related to polyphenol levels, but these attributes could not be adequately differentiated by the compositional variables under study. Wines that elicited a "puckery" sensation were characterized by relatively low anthocyanin levels, high acidity, and high pigmented polymer and tannin concentrations. The results of the study suggest that the in-mouth textural properties of Shiraz red wine are associated not only with their tannin composition and concentration but also with their acidity and anthocyanin and alcohol concentrations.