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Background The objective of this study was to determine whether the tear size of a supraspinatus tendon correlated with synovial inflammation and tendon degeneration in patients that underwent shoulder arthroscopy for rotator cuff repair. We hypothesized that increased synovial inflammation would correlate with greater tear size of the supraspinatus tendon at the time of surgery. Materials and Methods Tissue from the synovium, bursa, torn supraspinatus tendon and subscapularis tendon were obtained from patients during shoulder arthroscopy in order to evaluate the mRNA expression of pro-inflammatory cytokines, tissue remodeling and angiogenesis factors in the tendon, bursa, and synovium. Additional tissue was fixed to determine histological changes including inflammation, vascular ingrowths, and collagen organization. Results Increased expression of IL-1β, IL-6, COX-2, MMP-9, and VEGF was found in the synovium of patients with full-thickness tears versus partial-thickness tears (p<0.05). In the supraspinatus tendon, increased expression of MMP-1, -9, and -13 and VEGF was found in the full-thickness group. The upregulation of these genes in the full-thickness group was consistent with enhanced synovium inflammation, greater vascular ingrowth and the loss of collagen organization in both supraspinatus and subscapularis tendons as determined by histology. Conclusion Increased synovium inflammation and tissue degeneration correlates with the tear size of the supraspinatus tendon. A better understanding of the relationship between synovial inflammation and the progression of tendon degeneration can help design novel and effective treatments to limit the advance of rotator cuff diseases and to improve their clinical outcomes. Level of evidence Basic Science, Molecular and Cell Biology Study

implicit hazards associated with the boat maneuvering and exposure to the elements. Nonetheless, there have been significant tragedies. Recent improvements in safety gear and advances in technology have allowed for more acute medical management of sailors. Objective.-This study investigates the relative frequency of injuries and illnesses sustained during offshore sailboat racing in the Great Lakes, which has never been reported. These results will be compared with those published in a study that investigated the same occurrences during the Newport Bermuda ocean race to determine whether there is a difference in frequency or type found on the open ocean versus the Great Lakes. Methods.-The study design was prospective, descriptive, and observational. Surveys were self-reported and collected after the race from the boat representative. De-identified data were entered into a Microsoft Excel database and analyzed by a professional statistician. Results.-In 2013, representatives of 164 boats responded to the survey in one offshore race, which represented 1260 sailors; 146 illnesses were reported, and 9 boats reported at least 1 injury. In 2014, representatives of 435 boats responded to the survey in two offshore races, which represented 3525 sailors. The 2014 data are still being analyzed. Conclusions.-The 2013 rate of injury and illnesses in the Great Lakes was significant at 125 per 1000 races per sailor when compared with the Newport Bermuda race at only 12. Injuries in the form of contusions were most common in the Great Lakes races as opposed to lacerations in the ocean races, and seasickness was the most common illness in both environments. Background.-The provision of life-saving medical care in austere environments requires rescue team training in a simulated setting. Not every rescue organization has the capability to train in the field owing to weather, limited budgets, or schedule constraints. Objective.-We developed a competency-based curriculum for patient care providers using an indoor, easily reproducible,

Paper tape was found to prevent both the incidence and frequency of foot blisters in runners.