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Purpose: The initial interfragmentary motion (IFM) at a fracture site determines the mode of fracture healing. Understanding the impact of orthopaedic interventions on the fracture environment is essential to advancing our knowledge of fracture healing. The purpose of this scoping review is to analyze the orthopaedic literature to assess our understanding of the effects of early axial IFM on fracture healing outcomes., Methods: PubMed, OVID, and Scopus databases were queried to identify all studies from inception until June 2023 assessing axial IFM on fracture healing outcomes in animal and human subjects. We collected information regarding the amount of IFM, osteotomy/fracture location, experimental methodology, and outcomes (histologic, biomechanical, and radiographic evidence of fracture healing) for each study. Data synthesis is presented as a narrative review of our findings., Results: In total, 4,972 studies were identified. Fifteen studies were included, totaling 605 fractures/osteotomies. Of the included studies, 423 animal and 182 human subjects were examined. Nine studies investigated IFM at the tibia, four at the metatarsus, and two at the femur. The median time to analysis was nine weeks. The fracture gap size did not exceed 6 mm in any study. The range of IFM in tibias, metatarsi, and femurs was 0.3-2.0 mm, 0.1-2.4 mm, and 0.03-1.0 mm, respectively. No experiment using a femur model identified an association between early axial IFM and healing outcomes. All studies at the level of the tibia exhibited positive effects on callus formation with small-to-moderate axial IFM (mean 0.54, SD 0.30; range 0.2-0.9 mm). Most studies (9/13, 69.2%) found that early micromovement produced superior stiffness and biomechanical rigidity at the fracture site compared to absolute stability. While larger IFMs (mean 1.28, SD 0.70; range 0.25-2.4 mm) frequently led to a larger callus area, the callus quality and biomechanical strength of the callus was compromised., Conclusion: The definitive range of axial IFM conducive to a favorable healing environment remains elusive. However, preliminary evidence suggests an association between small-to-moderate (mean 0.41, SD 0.32; range: 0.03- 1.0 mm) initial axial IFM for stimulating successful fracture healing. This review found that the cumulative evidence present in the literature is insufficient to determine a definite correlation between the early axial IFM and outcomes., Competing Interests: Declaration of competing interest none, (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time., Purpose: Despite the effectiveness of antibiotic stewardship programs (ASPs) in improving antibiotic prescribing, these are rarely implemented in clinics serving underserved communities. Our objective was to understand patients' perspectives on the factors that can impact implementation of ASPs and integration of pharmacists in antibiotic prescribing in rural clinics., Methods: We conducted a survey using both quantitative questions and an open-ended question. To participate, patients had to receive care from a clinic serving low-income or rural communities and provide verbal consent to be included in the study. We analyzed the quantitative component of the data using descriptive statistics. The Pearson correlation coefficient was used to examine the relationship between respondents' knowledge of the prevalence of antibiotic resistance and their attitudes toward ASPs and pharmacist integration in antibiotic prescribing., Results: Of the 189 respondents who completed a survey, 51.3% were female and 51.3% were Caucasian. In our analysis, over 60% of patients reported knowing their prescribed antibiotics' names, while less than 30% possessed adequate knowledge of the indication and duration of the prescribed antibiotics. There was a positive correlation between knowledge about antibiotic resistance and being comfortable involving pharmacists in antibiotic prescribing (P < 0.01)., Conclusion: Many patients supported pharmacist involvement in antibiotic prescribing. Understanding patients' perceived attitudes will facilitate patient-centered, infrastructure-supported interventions by clinicians to improve antibiotic prescribing in the community., (© American Society of Health-System Pharmacists 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Objectives: To investigate the effect of tranexamic acid (TXA) through in vitro culture of primary human osteoblasts (HOB) and in vivo using an operative rat femur fracture model. It was hypothesized that there would not be any effect on fracture healing in both studies., Methods: Primary HOBs were exposed to varying concentrations of TXA over different time periods. Cells were assessed for viability, metabolism, and mineralization. For the in vivo model, fractures were created in the femora of adult rats, exposed to either TXA or saline, and then assessed for healing at different time points. A modified radiographic union score for tibia was used to evaluate radiographs, callus mineralization was assessed with microcomputed tomography, and biomechanical tests were performed., Results: Overall, HOB viability and metabolism decreased as TXA concentration and exposure time increased. However, at concentrations below 56.44 mg/mL, HOB viability was not affected. Similarly, mineralization also decreased as TXA concentration and exposure time increased. In both groups, in vivo results demonstrated increasing radiographic healing, callus mineralization, and biomechanical strength as a function of time. There was a trend for increased healing in the TXA group at 6 weeks after fracture; however, the difference compared with untreated animals was not statistically significant., Conclusions: Although a degradation of HOB viability and metabolism occurred with increased TXA concentrations and exposure times, clinically relevant concentrations do not adversely affect HOB viability, metabolism, or mineralization. In addition, there were no noticeable adverse effects of TXA administration in the in vivo model., Competing Interests: The authors report no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Although olecranon osteotomies are helpful for distal humerus visualization, traditional methods of fixation are commonly irritating for patients and require hardware removal. Recent studies have shown lower hardware removal rates for medullary screw constructs and 3.5-mm plates, but no studies have investigated the use of 2.7-mm plates for olecranon osteotomy fixation. The purpose of this study is to report on the outcomes of single 2.7-mm mini-fragment plate fixation of olecranon osteotomies for distal humerus intra-articular fractures., Methods: Patients who sustained an intra-articular distal humerus fracture, as identified by Current Procedural Terminology codes, were reviewed retrospectively over a 5-year study period (2016-2020) at a single level 1 trauma center after institutional review board approval. Only patients who underwent an olecranon osteotomy for distal humerus visualization during their definitive operation and that was subsequently fixed with a single 2.7-mm plate were included. Primary outcomes were implant removal and osteotomy union. Secondary outcomes included indications for implant removal, implant failure, infection, and revision surgery. Hardware removal rates were compared to historically reported rates in the literature. χ 2 vs. Fisher exact tests were used to compare fixation groups based on number of patients in each cohort (5 or less was used for the cutoff for Fisher exact test)., Results: Thirty-eight patients were included in the final analysis. The average age was 50 years (standard deviation [SD] 18), 58% (22 patients) were female, and the average follow-up time was 9.7 months (SD 5). All patients with mini-fragment plate fixation went on to union of their olecranon osteotomy. Three patients (7.8%) had their olecranon hardware removed for all causes: 1 for revision open reduction and internal fixation (ORIF), 1 for irritation, and 1 removal during concomitant capsulectomy and manipulation. There was a 21% (8 patients) revision surgery rate in the cohort but only 3 of those were for issues related to the olecranon osteotomy. One patient required revision ORIF of the olecranon osteotomy for hardware loosening. Compared with other fixation constructs, mini-fragment plates had a lower removal rate than tension band wiring (P = .0002) and 3.5-mm plates (P = .05) and similar among medullary screws ± wires. Nonunion rates were similar between all constructs (P = .07)., Conclusion: Single 2.7-mm mini-fragment plate fixation of olecranon osteotomies for distal humerus fractures is safe and effective with low rates of revision, hardware removal, and nonunion. This type of fixation should be considered when treating intra-articular distal humerus fractures that require an olecranon osteotomy., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Accumulating evidence has highlighted the acute and chronic impact of repetitive subconcussive head impacts (rSHIs) in contact sports. Neurofilament-light (Nf-L), a brain-derived biomarker of neuroaxonal injury, elevates in concert with rSHI. Recently, long-chain ω-3 polyunsaturated fatty acids (LC ω-3 PUFAs) supplementation has been suggested to mitigate brain injury from rSHI as reflected by attenuation of Nf-L concentrations within contact sport athletes., Objective: Using a systematic review with a meta-analysis, we aimed to determine the effect of LC ω-3 PUFA supplementation on Nf-L concentrations in athletes routinely exposed to rSHI., Methods: Electronic databases (PubMed and CINAHL) were searched from inception through January 2024. One-stage meta-analysis of individual participant-level data was used to detect changes in Nf-L concentrations between LC ω-3 PUFA and control/placebo (PL) groups from baseline to midseason (MS) and postseason (PS). Least square means (±SE) for Nf-L change from baseline were compared by treatment group for MS/PS using contrast t tests. Significance was set a priori at adjusted P ≤ 0.05., Results: Of 460 records identified, 3 studies in collegiate American football players (n = 179; LC ω-3 PUFA = 105, PL = 71) were included in the meta-analysis. Compared with PL, the change in Nf-L concentrations was statistically similar at MS [mean difference (MD) = -1.66 ± 0.82 pg·mL-1, adjusted P = 0.09] and significantly lower at PS (MD = -2.23 ± 0.83 pg·mL-1, adjusted P = 0.02) in athletes following LC ω-3 PUFA supplementation., Conclusions: Our findings demonstrate preliminary support for the prophylactic administration of LC ω-3 PUFA in contact sport athletes exposed to rSHI; however, further research is required to determine the effective dosage required.This trial was registered at OSF (DOI: https://doi.org/10.17605/OSF.IO/EY5QW).

Long-chain omega-3 polyunsaturated fatty acid (LC n -3 PUFA) supplements, rich in eicosapentaenoic acid and/or docosahexaenoic acid, are increasingly being recommended within athletic institutions. However, the wide range of doses, durations and study designs implemented across trials makes it difficult to provide clear recommendations. The importance of study design characteristics in LC n -3 PUFA trials has been detailed in cardiovascular disease research, and these considerations may guide LC n -3 PUFA study design in healthy cohorts. This systematic review examined the quality of studies and study design considerations used in evaluating the evidence for LC n -3 PUFA improving performance in physically trained adults. SCOPUS, PubMed and Web of Science electronic databases were searched to identify studies that supplemented LC n -3 PUFA in physically trained participants. Forty-six ( n = 46) studies met inclusion. Most studies used a randomised control design. Risk of bias, assessed using the design-appropriate Cochrane Collaboration tool, revealed that studies had a predominant judgment of 'some concerns', 'high risk' or 'moderate risk' in randomised controlled, randomised crossover or non-randomised studies, respectively. A custom five-point quality assessment scale demonstrated that no study satisfied all recommendations for LC n -3 PUFA study design. This review has highlighted that the disparate range of study designs is likely contributing to the inconclusive state of outcomes pertaining to LC n -3 PUFA as a potential ergogenic aid. Further research must adequately account for the specific LC n -3 PUFA study design considerations, underpinned by a clear hypothesis, to achieve evidence-based dose, duration and composition recommendations for physically trained individuals.

Optimal omega-3 status, influenced by increased intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), is vital for physiological health. This study investigated the impact of ad libitum fish oil supplementation on the omega-3 status of female athletes in a professional rugby league team during a competitive season. Twenty-four (n = 24) athletes participated, and their omega-3 status was assessed using the Omega-3 Index (O3I) and arachidonic acid (AA) to EPA ratio through finger-prick blood samples taken at the start and end of the season. They were given access to a fish oil supplement (PILLAR Performance, Australia) with a recommended daily dose of four capsules per day (2,160 mg EPA and 1,440 mg docosahexaenoic acid). At the beginning of the season, the group mean O3I was 4.77% (95% confidence interval [CI: 4.50, 5.04]) and the AA to EPA ratio was 14.89 (95% CI [13.22, 16.55]). None of the athletes had an O3I exceeding 8%. By the season's end, the O3I was a significantly increased to 7.28% (95% CI [6.64, 7.93], p < .0001) and AA to EPA ratio significantly decreased to a mean of 6.67 (95% CI [5.02, 8.31], p < .0001), driven primarily by the significant increase in EPA of +1.14% (95% CI [0.77, 1.51], p < .0001). However, these changes were varied between the athletes and most likely due to compliance. This study has demonstrated that using the objective O3I feedback scale is possible with elite female rugby athletes, but individual strategies will be required to achieve daily intake targets of EPA + DHA.

The Sudanese, in particular its male population, are known to utilise a smokeless tobacco product (Toombak) which is placed in the oral cavity and can be replaced several times a day. Toombak has been shown to harm human health and is highly addictive. The effect on body cortisol response over a retrospective period in users of this product has not been previously explored. In addition, psycho-dependency scores of Toombak users have not been analysed. In this study, 37 male subjects, age 18-45 years were recruited, of which 18 were non-users of Toombak and 19 were Toombak users. One hair sample was collected from each user and non-user of Toombak. Each hair sample (n=37) was placed in a pre-prepared long piece of foil with two labels on either side marked: 'scalp-side' and 'distant-side'. Cortisol was extracted by mincing 10 mg of 'scalp-side' hair, not exceeding 3 cm, with methanol addition, incubation, and sonication. Cortisol was measured using the enzyme-linked immunosorbent assay kit (Enzo Life Sciences, UK). The amount of hair cortisol in the samples was determined using spectrophotometry at wavelength 405 nm measured in pg/ml and visualised with a four parametric logistic curve. Toombak users were further asked to complete the Fagerstrom Test for Nicotine Dependence-Smokeless Tobacco questionnaire (FTND-ST) comprising of six questions. Scores of > 5 indicated a significant dependence, while a score of < 4 marked low to moderate dependence. The mean concentration of hair cortisol in Toombak users (9.7 pg/ml) was significantly lower (p=0.023) compared to non-users (19.4 pg/ml), with total concentrations ranging from 2.1 to 55.6 pg/ml. FTND-ST scores ranged from 4 to 9, with high levels of psycho-dependency (score > 5) and nicotine tolerance found in 85 % of Toombak users. Cortisol body release in Sudanese smokeless tobacco users was found to be significantly altered. While low cortisol levels do lead to anxiolytic effects, in the long-term, this can allow for increased susceptibility to low cortisol-associated diseases., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

It is well established that the gut microbiota plays an important role in host health and is perturbed by several factors including antibiotics. Antibiotic-induced changes in microbial composition can have a negative impact on host health including reduced microbial diversity, changes in functional attributes of the microbiota, formation, and selection of antibiotic-resistant strains making hosts more susceptible to infection with pathogens such as Clostridioides difficile. Antibiotic resistance is a global crisis and the increased use of antibiotics over time warrants investigation into its effects on microbiota and health. In this review, we discuss the adverse effects of antibiotics on the gut microbiota and thus host health, and suggest alternative approaches to antibiotic use., (© 2021 The Authors. MicrobiologyOpen published by John Wiley & Sons Ltd.)

Delayed onset muscle soreness (DOMS) following eccentric exercise is associated with increased inflammation which can be debilitating. Incorporation of long-chain omega-3 polyunsaturated fatty acids (LC n-3 PUFA), eicosapentaenoic acid, and docosahexaenoic acid into membrane phospholipids provides anti-inflammatory, proresolving, and analgesic effects. This systematic review aims to examine both the quality of studies and the evidence for LC n-3 PUFA in the attenuation of DOMS and inflammation following eccentric exercise, both which of course are empirically linked. The Scopus, Embase, and Web of Science electronic databases were searched to identify studies that supplemented fish oil for a duration of ≥7 days, which included DOMS outcomes following an eccentric exercise protocol. Fifteen (n = 15) studies met inclusion criteria. Eccentric exercise protocols varied from single to multijoint activities. Risk of bias, assessed using either the Cochrane Collaboration tool or the Risk of Bias in Nonrandomized Studies of Interventions tool, was judged as "unclear" or "medium," respectively, for the majority of outcomes. Furthermore, a custom 5-point quality assessment scale demonstrated that only one (n = 1) study satisfied current recommendations for investigating LC n-3 PUFA. In combination, this highlights widespread inappropriate design protocols among studies investigating the role of LC n-3 PUFA in eccentric exercise. Notwithstanding these issues, LC n-3 PUFA supplementation appears to have favorable effects on eccentric exercise-induced DOMS and inflammatory markers. However, the optimal LC n-3 PUFA supplemental dose, duration, and fatty acid composition will only become clear when study design issues are rectified and underpinned by appropriate hypotheses.

The aim of this study was to determine bacteriological stability of a probiotic mixture dispersed in various diluents. The commercially available probiotic (Infloran®), containing Bifidobacterium bifidum (10 9  CFU/250 mg tablet) and Lactobacillus acidophilus (10 9  CFU/250 mg tablet), was dispersed within expressed breast milk, sterile water, and infant formula and examined at temperatures of 4 and 21 °C. When stored at 4 °C, significant decreases (P < 0.05) in the level of L. acidophilus and B. bifidum were observed in expressed breast milk and sterile water after a 6-h period. However, when stored in infant formula, both strains remained stable over a 12-h period. When stored at 21 °C, a significant decrease (P < 0.05) was observed in the level of L. acidophilus in sterile water, expressed breast milk and infant formula throughout a 12-h period. However, no significant decrease was observed overtime in B. bifidum in all three diluents at this temperature., Conclusion: Our findings suggest that, when stored at 4 °C, this probiotic product can remain at a stable condition for 6 h in sterile water and infant formula; however, the viability of the probiotic decreases significantly after this period of time. Administration of this probiotic in sterile water can be an acceptable alternative to dispersion and administration in expressed breast milk. What is Known: • Administration of probiotics containing lactobacilli and bifidobacteria has become more widespread in neonatology, mainly as prophylaxis for the prevention of necrotising entercolitis in preterm infants. • Probiotic reconstitution, from its powder base, is not standardized and various diluents, including sterile water, breast milk, and infant formula, have been used. What is New: • When stored at 4 °C, a probiotic containing lactobacilli and bifidobacteria remains at a stable microbological condition for up to 6 h in sterile water. • Administration of this probiotic dispersed in sterile water, followed by an EBM feed, can be an acceptable alternative to dispersion and administration in EBM.

Microbial colonization of the gastrointestinal tract is an essential process that modulates host physiology and immunity. Recently, researchers have begun to understand how and when these microorganisms colonize the gut and the early-life factors that impact their natural ecological establishment. The vertical transmission of maternal microbes to the offspring is a critical factor for host immune and metabolic development. Increasing evidence also points to a role in the wiring of the gut-brain axis. This process may be altered by various factors such as mode of delivery, gestational age at birth, the use of antibiotics in early life, infant feeding, and hygiene practices. In fact, these early exposures that impact the intestinal microbiota have been associated with the development of diseases such as obesity, type 1 diabetes, asthma, allergies, and even neurodevelopmental disorders. The present review summarizes the impact of cesarean birth on the gut microbiome and the health status of the developing infant and discusses possible preventative and restorative strategies to compensate for early-life microbial perturbations., (© The Author(s) 2017. Published by Oxford University Press on behalf of the International Life Sciences Institute.)

Background: The role of transesophageal echocardiography (TEE) simulation in cardiology fellows' learning is unknown. Standard TEE training at the authors' institution occurs during the second of 3 clinical years. Fellows spend 2 months in the TEE laboratory learning through hands-on experience. The addition of TEE simulation to this experience may improve proficiency, speed learning, and increase fellows' comfort with TEE. This study was designed to compare methods of TEE simulator training with standard training., Methods: Group A (n = 8) consisted of fellows who had completed standard TEE training. Fellows starting their second clinical year were randomly assigned to group B (n = 10), simulator training during month 1, or group C (n = 9), simulator training during month 2. All groups completed 2 months of standard TEE training. All groups underwent assessment of TEE performance and a self-assessment of ability and comfort level with TEE., Results: Groups B and C had higher total assessment scores than group A. Groups B and C had higher numbers of views achieved without assistance (P = .01). After month 1, group B had higher total scores and number of views achieved without assistance compared with group C (P = .02 and P = .02, respectively). The length of time of the examination tended to be lower for group B, and fellows in group B had greater comfort with TEE than those in group C (P = .01)., Conclusions: These data suggest that TEE simulator training improves proficiency and helps speed learning and comfort with TEE., (Copyright © 2013 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.)

Intracardiac thrombus is a condition of increasing clinical significance not only because of its potential complications but also because of the lack of clinical evidence to guide clinicians in selecting optimal therapies. Thus, 2 recent cases encountered at the Vanderbilt University Medical Center illustrate the clinical challenges one may encounter in patients with intracardiac thrombus. A careful review of the diagnostic challenges, potential complications and current recommendations for management are presented.

Background: The availability of stored intracardiac electrograms from implantable defibrillators (ICDs) has facilitated the study of the mechanisms of ventricular tachyarrhythmia onset. This study aimed to determine the patterns of initiation of ventricular fibrillation (VF) in Multicenter Automatic Defibrillator Implantation Trial (MADIT) II patients along with associated electrocardiogram (ECG) parameters and clinical characteristics., Methods: Examination of stored electrograms enabled us to evaluate the rhythm preceding each episode of VF and to calculate (intracardiac) ECG parameters including QT, QT peak (QTp), coupling interval, and prematurity index., Results: Sixty episodes of VF among 29 patients (mean age 64.4 +/- 2.5 years) were identified. A single ventricular premature complex (VPC) initiated 46 (77%) episodes whereas a short-long-short (SLS) sequence accounted for 14 (23%) episodes. Of the 29 patients studied, 23 patients had VF episodes preceded by a VPC only, two patients with SLS only, and four patients with both VPC and SLS-initiated episodes. There were no significant differences between initiation patterns in regards to the measured ECG parameters; a faster heart rate with SLS initiation (mean RR prior to VF of 655 +/- 104 ms for SLS and 744 +/- 222 ms for VPC) approached significance (P = 0.06). The two patients with SLS only were not on beta-blockers compared to 83% of the VPC patients., Conclusion: Ventricular fibrillation is more commonly initiated by a VPC than by a SLS sequence among the MADIT II population. Current pacing modes designed to prevent bradycardia and pause-dependent arrhythmias are unlikely to decrease the incidence of VPC-initiated episodes of VF.

Walking is the most common aerobic training modality utilized in cardiac rehabilitation programs. However, it remains unclear whether or not brisk walking is of a sufficient intensity to improve aerobic fitness in this population. In this study, we investigated whether men and women with coronary artery disease can achieve an exercise intensity that is sufficient to induce a training effect, ie, a training heart rate (THR), defined as >/= 70% of measured maximal heart rate (HRmax), via brisk walking on a flat surface. One hundred forty-two outpatient volunteers from the William Beaumont Hospital Cardiac Rehabilitation Program (Royal Oak, MI) and the University of Wisconsin-La Crosse Exercise and Health Program (La Crosse, WI) were asked to walk one mile as briskly as possible on measured tracks. Heart rate was monitored throughout the walk via radiotelemetry. The percentage of patients within each gender and phase of rehabilitation who attained a THR were assessed using peak or symptom-limited exercise testing to determine the HRmax. All of the women and 90% of the men achieved a THR, averaging 85 +/- 8% and 79 +/- 10% of HRmax, respectively (mean +/- SD). There was no difference in the percentage of phase II or phase III cardiac rehabilitation program patients who achieved a THR. These findings suggest that brisk walking is of a sufficient intensity to elicit a THR in all but the most highly fit patients with coronary disease. Thus, physicians and allied health professionals can prescribe brisk walking on a flat surface to their cardiac patients with confidence that this intensity will achieve cardiorespiratory and health benefits.