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Regeneration of large bone defects remains a clinical challenge until today. While existing biomaterials are predominantly addressing bone healing via direct, intramembranous ossification (IO), bone tissue formation via a cartilage phase, so-called endochondral ossification (EO) has been shown to be a promising alternative strategy. However, pure biomaterial approaches for EO induction are sparse and the knowledge how material components can have bioactive contribution to the required cartilage formation is limited. Here, we combined a previously developed purely architecture-driven biomaterial approach with the release of therapeutic metal ions from tailored silicate microparticles. The delivery platform was free of calcium phosphates (CaP) that are known to support IO but not EO and was employed for the release of lithium (Li), magnesium (Mg), strontium (Sr) or zinc (Zn) ions. We identified an ion-specific cellular response in which certain metal ions strongly enhanced cell recruitment into the material and showed superior chondrogenesis and deposition collagen II by human mesenchymal stromal cells (MSCs). At the same time, in some cases microparticle incorporation altered the mechanical properties of the biomaterial with consequences for cell-induced biomaterial contraction and scaffold wall deformation. Collectively, the results suggest that the incorporation of metal-doped silicate microparticles has the potential to further improve the bioactivity of architectured biomaterials for bone defect healing via EO. Endochondral bone healing, a process that resembles embryonic skeletal development, has gained prominence in regenerative medicine. However, most therapeutic biomaterial strategies are not optimized for endochondral bone healing but instead target direct bone formation through IO. Here, we report on a novel approach to accelerate biomaterial-guided endochondral bone healing by combining cell-guiding collagen scaffolds with therapeutic metal-doped silicate microparticles. While other strategies, such as hypoxia-mimic drugs and iron-chelating biomaterials, have been documented in the literature before to enhance EO, our approach uniquely implements enhanced bioactivity into a previously developed biomaterial strategy for bone defect regeneration. Enhanced cell recruitment into the material and more pronounced chondrogenesis were observed for specific hybrid scaffold formulations, suggesting a high relevance of this new biomaterial for improved endochondral bone healing. [Display omitted] [ABSTRACT FROM AUTHOR]

This summary of the proceedings of the 2023 ACR Intersociety Meeting discusses the seven most important challenges facing radiology today: declining reimbursement, corporatization and consolidation, inadequate labor force, imaging appropriateness, burnout, turf wars with nonphysicians, and workflow efficiency. Participants in the Intersociety Summer Conference-2023 focused their effort on identifying potential solutions given how critical these topics are to the sustainability of the profession. [ABSTRACT FROM AUTHOR]

The performance of electrodeposited coatings is usually very dependent on the operating conditions. Current density can have a major effect on the appearance of electrodeposits, their physical/mechanical properties and corrosion resistance. In the present study, HAp-Nb2O5 composite layers were electrodeposited on NiTi from stirred, aqueous electrolytes, containing 1 g dm−3 of suspended Nb2O5 particles at a current density of 10, 15 or 20 mA cm−2. The morphology, topography, and elemental composition of the surface were determined using FESEM, AFM, and EDS, respectively. A higher current density enhanced the content of co-deposited Nb2O5 particles but risked the formation of particle aggregation. Microhardness and corrosion, carried out by the Vickers microhardness and potentiodynamic polarization techniques, illustrated that the films electroplated at 15 mA cm−2 showed the highest corrosion resistance performance and the least Ni2+ ion leaching. The results may aid the development of high-performance coatings on NiTi in orthopaedic applications.. [ABSTRACT FROM AUTHOR]

Objective: To assess the antiviral activity, pharmacokinetics, and safety of MK-6186 in HIV-1 non-nucleoside reverse transcriptase inhibitor (NNRTI)-naïve, HIV-1-infected male participants. Design: Double-blind, randomized, two-panel study. Methods: In 2 sequential panels, 18 participants received MK-6186 (40 mg [Panel A] or 150 mg [Panel B]) or matching placebo once daily for 7 days. Plasma samples were collected for measurement of HIV-1 RNA levels and MK-6186 pharmacokinetics. Results: For the mean change from baseline in HIV-1 RNA (log10 copies/mL) at 24 h post Day 7 dose, the mean difference (90% confidence interval) between MK-6186 and placebo was −1.54 (−1.73, −1.34) in the 40-mg group and −1.28 (−1.81, −0.75) in the 150-mg group. One participant in the 150-mg group had viral rebound at 24 h after Day 6 dosing (Day 7 predose) associated with outgrowth of the V106A minority variant. Ultra-deep sequencing confirmed expansion of this predose minority variant from 0.26% to 63.67%. No outgrowth or rebound was seen in another participant in whom a V106A minority variant was also detected. MK-6186 was generally well tolerated. MK-6186 was rapidly absorbed with peak concentrations at 2 h followed by a biphasic decline. The effective t½ of MK-6186 was 43.9 to 48.7 h. Steady state was not achieved. Conclusions: Daily monotherapy with MK-6186 demonstrated robust antiviral activity with maximal antiviral activity at a dose of 40 mg. One participant in the 150-mg group exhibited viral rebound with outgrowth of the resistant V106A minority variant, demonstrating a risk of resistance development typical of NNRTIs. The reason for this outgrowth remains unclear as no outgrowth occurred in a participant in the 40-mg group in whom the V106A minority variant was also detected. MK-6186 may be an alternative next-generation NNRTI in combination therapy, in that combination antiretroviral therapy could prevent outgrowth of resistant minority variants. [ABSTRACT FROM AUTHOR]

The formation of functional bone requires a delicate interplay between osteogenesis and osteolysis. Disturbances in this subtle balance result in an increased risk for fractures. Besides its mechanical function, bone tissue represents a key player in the regulation of calcium homeostasis. Impaired bone formation results in bone fragility, which is especially pronounced in osteogenesis imperfecta (OI). This rare genetic disorder is characterized by frequent fractures as well as extraskeletal manifestations. The current classification of OI includes 23 distinct types. In recent years, several new mutations in different genes have been identified, although the exact pathomechanisms leading to the clinical presentation of OI often remain unclear. While bisphosphonates are still the standard of care, novel therapeutic approaches are emerging. Especially, targeted antibody therapies, originally developed for osteoporosis, are increasingly being investigated in children with OI and represent a promising approach to alleviate the consequences of impaired osteogenesis and improve quality of life in OI patients. This review aims to provide insight into the pathophysiology of OI and the consequences of distinct disease-causing mutations affecting the regulation of bone homeostasis. In this context, we describe the four most recently identified OI-causing genes and provide an update on current approaches for diagnosis and treatment. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate whether an A-PRF + membrane can lower the fistula rate in patients undergoing primary palatoplasty. A total of 20 children were included: 10 were randomized and included in the platelet-rich fibrin (PRF) group, and 10 were assigned to the control group. Before two-flap palatoplasty was performed, the cleft's width was measured. The patients in the PRF group underwent an intraoperative collection of 5 ml venous blood, which was centrifugated and pressed onto an A-PRF + membrane. Subsequently, the membrane was placed between the oral and nasal mucosal layers. The control group underwent the same procedure without the addition of A-PRF+. The need for transfusions or postoperative intensive care was registered. All children were followed up at 10 days, 1, 2, 3, and 6 months, and after more than 6 months and the occurrence of fistulae and need for a second palatal operation was then evaluated. After more than six months postoperatively, only two fistulae (10%) remained and had to undergo secondary palatoplasty (p = 1.00). Moreover, the blood transfusion rate did not differ significantly (p = 1.00). A-PRF + might be beneficial in cleft closure, but further randomized studies with larger patient cohort are needed. [ABSTRACT FROM AUTHOR]

The use of high-flow nasal cannulas (HFNC) in patients admitted to the pediatric intensive care unit (PICU) has gradually increased worldwide; however, details on clinical efficacy remain limited in Taiwan. Therefore, we explored the clinical characteristics and outcomes of pediatric patients using HFNC in the PICU. Medical records were retrospectively collected from pediatric patients (aged <18 years) who received HFNC support from December 2021 to January 2023 in the PICU of a medical center. Outcome parameters included treatment failure (defined as increased respiratory support to advanced non-invasive ventilators or intubations), duration of support from HFNC, and changes in clinical parameters after initiating HFNC. A total of 261 episodes of HFNC use were included, with a failure rate of 24.5% and a median support length of 4 days. Multivariable analysis showed that infant age (adjusted odds ratio [aOR]: 2.1, p = 0.02) and accompanying complex chronic disease (aOR: 4.4, p = 0.014) were risk factors for treatment failure and a diagnosis of asthma or bronchiolitis had a lower hazard of treatment failure (aOR: 0.29, p = 0.025) than other diagnoses did. Improvements in clinical parameters, including pulse rate, respiratory rate, SpO 2 , and CO 2 levels, were observed 24 h after the initiation of HFNC. The application of HFNC in the PICU in Taiwan is effective but should be performed with care in infants with accompanying complex chronic diseases. In addition to low treatment failure, HFNC utilizations stabilized the clinical parameters of children with asthma/bronchiolitis within one day. [ABSTRACT FROM AUTHOR]

Biological disasters pose a growing challenge in the 21st century, significantly impacting global society. Taiwan has experienced such disasters, resulting in long-term consequences like loss of life, trauma, economic decline, and societal disruptions. Post-disaster, mental health issues such as fear, anxiety, depression, post-traumatic stress disorder (PTSD), and stress surge, accompanied by increased suicide rates. The Coronavirus disease 2019 (COVID-19) (also called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) pandemic, recognized as a biological disaster, triggered lockdowns and quarantines in Taiwan, causing lifestyle changes, economic recession, and so on. These shifts may elevate uncertainty about the future, intensifying mental stress and leading to a rise in various mental illnesses. This article reviews mental health studies conducted in Taiwan during the pandemic, emphasizing the need to integrate this research for future preparedness and interventions regarding the mental health impacts of biological disasters, including COVID-19. Further research is essential to explore long-term effects, interventions, and generalizability. [ABSTRACT FROM AUTHOR]

This article discusses concepts related to character strengths and positive youth development and how these ideas can be applied to improve outcomes among gifted young people. A theory with roots in public health, The Theory of Triadic Influence (TTI), is discussed with examples applied to gifted populations. Practitioners and researchers from several fields have used the TTI to better understand behavior and to inform program development/evaluation efforts that have improved young people's outcomes including those related to substance use, dietary behaviors, and physical activity. The TTI may be helpful for researchers and practitioners intending to understand and change both cognitive and affective/emotional influences that play a role in shaping the behaviors of gifted young people. In addition, we review intervention/evaluation studies that seek to improve outcomes among young people (in general) and gifted young people (in particular) and share ideas for future efforts to improve outcomes among gifted populations. [ABSTRACT FROM AUTHOR]

We aimed to assess the impact of complex mitral valve disease and patient risk profile on operative outcomes in the large cohort of the Mini-Mitral International Registry. Patients were assigned to categories of complex degenerative mitral valve regurgitation (DMR; bileaflet or anterior mitral leaflet prolapse/flail) and simple DMR (posterior mitral leaflet prolapse/flail). Subgroup analyses was performed in low-risk (EuroSCORE II <8%) and high-risk (EuroSCORE II >8%) cohorts. A logistic regression model was applied to investigate the impact of valve anatomy and patient risk factors on valve repair rate and operative risk. The study cohort consisted of 4524 patients with DMR (complex DMR, 1296; simple DMR, 3228). Valve repair rate was 87.3% and 91% in complex DMR and simple DMR, respectively. Predictors of valve replacement were anterior leaflet prolapse/flail, bileaflet flail, female sex, age, and reoperation, whereas Barlow disease was protective. Clinical results were comparable between complex DMR and simple DMR. On subgroup analyses, high-risk patients showed less satisfactory outcomes with respect to both the valve repair and operative mortality rates. Our findings suggest that complex DMR can be satisfactorily addressed by minimally invasive techniques. However, whereas complex disease was associated with low operative risk, anterior leaflet lesions and bileaflet flail remain negative predictors of successful valve repair. Conversely, valve repair rate was less satisfactory in high-risk patients, regardless of DMR complexity. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: In the last 2 decades the development of high-resolution manometry (HRM) has changed and revolutionized the diagnostic assessment of patients complain foregut symptoms. The role of HRM before and after antireflux procedure remains unclear, especially in surgical practice, where a clear understanding of esophageal physiology and hiatus anatomy is essential for optimal outcome of antireflux surgery (ARS). Surgeons and gastroenterologists (GIs) agree that assessing patients following antireflux procedures can be challenging. Although endoscopy and barium-swallow can reveal anatomic abnormalities, physiological information on HRM allowing insight into the cause of eventually recurrent symptoms could be key to clinical decision-making. Methods: A multidisciplinary international working group (14 surgeons and 15 GIs) collaborated to develop consensus on the role of HRM pre-ARS and post-ARS, and to develop a postoperative classification to interpret HRM findings. The method utilized was detailed literature review to develop statements, and the RAND/University of California, Los Angeles Appropriateness Methodology (RAM) to assess agreement with the statements. Only statements with an approval rate >80% or a final ranking with a median score of 7 were accepted in the consensus. The working groups evaluated the role of HRM before ARS and the role of HRM following ARS. Conclusions: This international initiative developed by surgeons and GIs together, summarizes the state of our knowledge of the use of HRM pre-ARS and post-ARS. The Padova Classification was developed to facilitate the interpretation of HRM studies of patients underwent ARS. [ABSTRACT FROM AUTHOR]

To present hospital compliance with federal price transparency regulations for sports medicine procedures. Online price estimator and machine-readable files were recovered for U.S. News and World Report 's top 100 orthopaedic hospitals. From June to November 2023, compliance and monetary values were recorded for each of Centers for Medicare and Medicaid Services price transparency regulations. Price estimator data were assessed on the basis of hospital placement in the bottom and top 50 of the 100 institutions under review, as well as by region (Northeast, South, Midwest, West). Statistical analyses included 2-sample t tests and Kruskal-Wallis tests. In total, 95% of hospitals had a price estimator tool for both subacromial decompression (Current Procedural Terminology [CPT] code 29826) and meniscectomy (CPT code 29881). Only 38% were compliant with all regulations for subacromial decompression and 39% for meniscectomy; the remaining did not list minimum or maximum procedure charges. Higher-ranked hospitals were significantly more likely to charge a greater cash price for subacromial decompression and meniscectomy (P =.040 and P =.009, respectively). Compliance with machine-readable file reporting was poor, with less than 20% meeting requirements for each CPT code. Reported prices varied greatly by hospital. This study demonstrates that U.S. News and World Report 's top 100 orthopaedic hospitals exhibit poor overall compliance with federal price transparency regulations for sports medicine procedures. Most often they lack full compliance by not reporting minimum or maximum charges as part of their price estimator tool or do not report procedure prices in their machine-readable files. Hospitals also exhibit wide variation in prices reported for specific procedures. Consumer price transparency continues to be an important goal in health care, as it allows patients to make informed decisions when selecting appropriate treatment options and providers. To realize the full benefits of price transparency, hospitals should address areas of improvement. [ABSTRACT FROM AUTHOR]

Evidence regarding the effect of body mass index (BMI) on complications following anatomic shoulder arthroplasty (aTSA) and reverse shoulder arthroplasty (rTSA) remains controversial. This high-powered study examines the effect of BMI on surgical and medical complications following aTSA and rTSA. This retrospective cohort study was conducted using the Premier Healthcare Database to query all adult patients who underwent primary, elective TSA (aTSA, rTSA) from 2016 to 2020. Patients eligible for inclusion were identified using International Classification of Diseases -10 and CPT codes for primary TSA. Patients were stratified into 3 subgroups based on BMI (BMI <30 kg/m2, BMI 30-35 kg/m2, BMI >35 kg/m2). The primary endpoints assessed were 90-day risks of postoperative complications, revisions, and readmissions among the 3 BMI groups undergoing primary TSA. A total of 32,645 patients were analyzed; 10,951 patients underwent aTSA and 21,694 patients underwent rTSA. Patient populations for aTSA and rTSA differed significantly across all BMI categories in terms of age, sex, cost of care, and insurance status. After multivariate regression analysis, there was no increased risk of surgical complications in the aTSA and rTSA cohorts with BMI 30-35 kg/m2 and BMI >35 kg/m2. In the aTSA cohort, rates of acute respiratory failure (adjusted Odds Ratio [aOR] 2.65) was all significantly higher in the BMI >35 kg/m2 group. As for rTSA cohort, acute respiratory failure (aOR 1.67) and acute renal failure (aOR 1.53) were significantly higher in the BMI >35 kg/m2 group. While we found no increased risk of immediate postoperative surgical risks, patients with a BMI >35 kg/m2 demonstrated greater risk of medical complications after rTSA. Given this trend, providers should exercise caution in patient selection for TSA and counsel obese patients as to these increased risks. Future studies should aim to provide a more comprehensive picture of the effect of BMI on functional outcomes after TSA. [ABSTRACT FROM AUTHOR]

Perioperative intravenous (IV) dexamethasone is commonly used in lower extremity total joint arthroplasty to manage postoperative pain and nausea/vomiting, and recent studies have demonstrated that its use may lower rates of acute postoperative medical complications. However, there is limited information regarding the safety and efficacy of IV dexamethasone in patients undergoing total shoulder arthroplasty (TSA). Additionally, there is concern surrounding corticosteroid use prior to surgery as preoperative corticosteroid injections have been associated with adverse outcomes after TSA, including periprosthetic joint infection (PJI) and revision surgery. Thus, the purpose of this study was to evaluate the effect of perioperative IV dexamethasone on 90-day rates of PJI, wound complications, and medical complications after TSA. The Premiere national hospital database was used to identify adult patients undergoing elective TSA between 2016 and 2020; patients were excluded if they were under 18 years old, were undergoing revision TSA, or had a prior proximal humerus open reduction internal fixation procedure. Patients who did and did not receive perioperative IV dexamethasone were then compared in both univariate and multivariate analyses. A Bonferroni correction was utilized to adjust for multiple comparisons. The primary end point was risk of acute infectious complications within 90 days of surgery, including PJI and wound infection/dehiscence. Secondary end points included acute pulmonary, renal, and thromboembolic complications. A total of 135,333 patients underwent TSA during the study period; 61.2% underwent reverse total shoulder arthroplasty, 33.8% underwent anatomic total shoulder arthroplasty, and 5.0% underwent hemiarthroplasty. From 2016 to 2020, perioperative IV dexamethasone use increased by 135%. Multivariate analysis revealed that patients who received perioperative IV dexamethasone did not have increased odds of PJI, superficial wound infection, or wound dehiscence (P =.15-.47) but did have decreased odds of sepsis (odds ratio [OR] 0.67, 95% confidence interval [CI] 0.55-0.81) and other medical complications such as urinary tract infection and acute kidney injury. Additionally, there was a trend towards decreased 90-day hospital readmission (OR 0.88, 95% CI 0.81-0.96, P =.003). Perioperative IV dexamethasone was not associated with increased risk of acute infectious and wound healing complications. Moreover, patients who received perioperative IV dexamethasone had decreased odds of medical complications and trended toward lower rates of 90-day hospital readmission. The results of this study support the safety of perioperative IV dexamethasone use in patients undergoing elective TSA. [ABSTRACT FROM AUTHOR]

Social norms influence homophobic behavior, yet these norms are often misperceived. We study the extent to which friendship ties and group memberships are related to misperceptions of opinions towards homosexuality, and how these misperceptions are sustained in social networks through opinion sharing. We find that misperceptions lead individuals to be less willing to share their opinions with ethno-religious ingroup members, non-friends or with individuals whom they perceive to hold different opinions. Although differences observed in the context of this study are relatively small, they may add up over time. These results offer scope for interventions that try to reduce norm misperceptions between groups - as a way to stimulate social change towards a more tolerant society. • We studied whether students misperceived others' opinions towards homosexuality, and how this relates to opinion sharing. • Others' perceived opinions affected students' opinion sharing, yet these perceptions were often inaccurate. • In a counterfactual simulation, correcting misperceptions of opinions did not substantially change opinion sharing by students. • Students were more willing to share opinions with friends and ingroup members, irrespective of their opinions. • Correcting misperceptions increased opinion sharing with others whose opinions were originally (mis)perceived as opposite. [ABSTRACT FROM AUTHOR]

Background: Changes in cortical activation patterns after rupture of the anterior cruciate ligament (ACL) have been described. However, evidence of these consequences in the early stages following the incident and through longitudinal monitoring is scarce. Further insights could prove valuable in informing evidence-based rehabilitation practices. Purpose: To analyze the angular accuracy, neuromuscular, and cortical activity during a knee joint position sense (JPS) test over the initial six months following ACL reconstruction. Study design: Cohort Study Methods: Twenty participants with ACL reconstruction performed a JPS test with both limbs. The measurement time points were approximately 1.5, 3-4 and 6 months after surgery, while 20 healthy controls were examined on a single occasion. The active JPS test was performed seated with a target angle of 50° for two blocks of continuous angular reproduction (three minutes per block). The reproduced angles were recorded simultaneously by an electrogoniometer. Neuromuscular activity of the quadriceps muscles during extension to the target angle was measured with surface electromyography. Spectral power for theta, alpha-2, beta-1 and beta-2 frequency bands were determined from electroencephalographic recordings. Linear mixed models were performed with group (ACL or controls), the measurement time point, and respective limb as fixed effect and each grouping per subject combination as random effect with random intercept. Results: Significantly higher beta-2 power over the frontal region of interest was observed at the first measurement time point in the non-involved limb of the ACL group in comparison to the control group (p = 0.03). Despite individual variation, no other statistically significant differences were identified for JPS error, neuromuscular, or other cortical activity. Conclusion: Variation in cortical activity between the ACL and control group were present, which is consistent with published results in later stages of rehabilitation. Both indicate the importance of a neuromuscular and neurocognitive focus in the rehabilitation. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]