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Radiation-related lymphopenia has been associated with suboptimal tumor control rates leading to inferior survival outcomes. To date, no standardized dose constraints are available to limit radiation dose to resident and circulating lymphocyte populations. We undertook this systemic review of the literature to provide a synopsis of the dosimetric predictors of radiation-related lymphopenia in solid malignancies.A systematic literature review of PubMed (National Institutes of Health), Cochrane Central (Cochrane collaboration), and Google Scholar was conducted with the following keywords: "radiation", "lymphopenia", "cancer", "dosimetric predictors" with an inclusion deadline of May 31, 2022. Studies that met prespecified inclusion criteria were designated either Good, Fair, or Poor Quality based on the Newcastle-Ottawa quality assessment. The dosimetric parameters derived from Good Quality studies were tabulated as LymphoTEC dose constraints. Dosimetric parameters derived from Fair and Poor-quality studies were grouped as optional.An initial systematic search of the literature yielded 1,632 articles. After screening, a total of 48 studies met inclusion criteria and were divided into the following categories: central nervous system (CNS, 6), thoracic (11), gastrointestinal (26), gynecologic (2), head and neck, breast, and genitourinary (one each) cancers. Lung mean dose, heart mean dose, brain V25, spleen mean dose, estimated dose to immune cells, and bone marrow V10 were among the strongest predictors for severe lymphopenia related to radiotherapy.Optimizing the delivery of radiation therapy to limit dose to lymphocyte-rich structures may curb the negative oncologic impact of lymphocyte depletion. The dose constraints described herein may be considered for prospective validation and future use in clinical trials to limit risk of radiation-related lymphopenia and possibly improve cancer-associated outcomes.

Background: Meniscal pathology is commonly encountered in the setting of anterior cruciate ligament (ACL) rupture and is increasingly common in the pediatric and adolescent population. Studies have shown that over half of individuals presenting with ACL rupture will have concurrent meniscal pathology. Purpose: To define trends in the utilization of meniscal procedures (ie, meniscus repair vs partial meniscectomy) and short-term complications in pediatric and young adult patients with meniscal pathology in the setting of a concurrent ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: The IBM MarketScan Commercial Database was utilized to identify ACL reconstruction procedures performed between 2006 and 2018 for individuals aged 5 to 30 years. Annual proportions of meniscectomy and meniscal repair were analyzed, and short-term complications were compared between pediatric/adolescent patients (aged 5-17 years) and young adults (aged 18-30 years). Results: An overall 40,736 records of individuals Conclusion: From 2006 to 2018, the proportion of patients receiving ACL reconstruction with concomitant meniscal repair increased (20.1% to 35.1%) while the proportion with meniscectomy decreased (34.4% to 21.3%) in the pediatric/adolescent population. Meniscal repair was not associated with a higher 180-day rate of reoperation for repeat meniscal repair or meniscectomy than meniscectomy in the setting of ACL reconstruction.

The utilization of meniscal repair techniques continues to evolve in an effort to maximize the rate of healing. Meniscal repair outcomes at a minimum of 5 years postoperatively appear to better represent the true failure rates. Thus, a systematic review and meta-analysis of the current literature was conducted to assess the rate of failure at a minimum of 5 years after meniscal repair.We performed a systematic review of studies reporting the outcomes of meniscal repair at a minimum of 5 years postoperatively. A standardized search and review strategy was utilized. Failure was defined as recurrent clinical symptoms or a meniscal reintervention to repair or resect the meniscus in any capacity, as defined by the study. When reported, outcomes were assessed relative to anterior cruciate ligament (ACL) status, sex, age, and postoperative rehabilitation protocol. Meta-analyses were performed with a random-effects model.A total of 27 studies of 1,612 patients and 1,630 meniscal repairs were included in this review and meta-analysis. The pooled overall failure rate was 22.6%, while the failure rate of modern repairs (excluding early-generation all-inside devices) was 19.5%. Medial repairs were significantly more likely to fail compared with lateral repairs (23.9% versus 12.6%, p = 0.04). Failure rates were similar for inside-out (14.2%) and modern all-inside repairs (15.8%). Early-generation all-inside devices had a significantly higher failure rate (30.2%) compared with modern all-inside devices (15.8%, p = 0.01). There was no significant difference in meniscal failure rate between repairs with concomitant ACL reconstruction (21.2%) and repairs in ACL-intact knees (23.3%, p = 0.54).Modern meniscal repair had an overall failure rate of 19.5% at a minimum of 5 years postoperatively. Modern all-inside techniques appear to have improved the success rate of meniscal repair compared with use of early-generation all-inside devices. Lateral repairs were significantly more likely to be successful compared with medial repairs, while no difference was seen between patients undergoing meniscal repair with and without concomitant ACL reconstruction.Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Numerous studies have demonstrated an increase in the number of anterior cruciate ligament (ACL) reconstruction procedures performed in pediatric patients. Despite this, most knowledge of surgical site infection rates after these procedures are based on adult studies and data is currently limited in pediatric patients. The purpose of this study was to describe and analyze the rates of infection after ACL reconstruction among pediatric patients and adolescent patients (compared with young adult patients) utilizing the MarketScan Commercial Claims and Encounters Database.The Truven Health Analytics MarketScan Commercial Claims and Encounters database was assessed to access health care utilization data for privately insured individuals aged 5 to 30 years old. ACL reconstruction records performed between 2006 and 2018 were identified using Current Procedures Terminology (CPT) codes. International Classification of Diseases Ninth Revision (ICD-9), Tenth (ICD-10) codes and CPT codes were used to identify patients requiring treatment for infection. All patients had at least 180 days of insurance coverage after intervention.A total of 44,501 individuals aged below 18 years old and 63,495 individuals aged 18 to 30 years old that underwent arthroscopic ACL reconstruction were identified. There were no differences in infection rates between those below 18 years old (0.52%) and those above 18 years old (0.46%, P=0.227). However, among patients below 18 years old, patients below 15 years old had a significantly lower rate of infection at 0.37% compared with adolescents (15 to 17 y old) at 0.55% (P=0.039). Among young adults, males had higher rates of infection than females (0.52% vs. 0.37%), while no difference was observed in the pediatric and adolescent population (0.58% vs. 0.47%, P=0.109).Utilizing an insurance database, this study demonstrated that rates of infection after ACL Reconstruction in a pediatric/adolescent population are low (0.52%) and similar to rates in young adults. Infection rates after ACLR reconstruction appear to be slightly lower in patients under 15 years of age (0.37%).Level III-Retrospective comparative study.

Biomarkers for the early diagnosis of hepatocellular carcinoma (HCC) are needed to decrease mortality from this cancer. However, as new biomarkers have been slow to be brought to clinical practice, we have developed a diagnostic algorithm that utilizes commonly used clinical measurements in those at risk of developing HCC. Briefly, as α-fetoprotein (AFP) is routinely used, an algorithm that incorporated AFP values along with four other clinical factors was developed. Discovery analysis was performed on electronic data from patients who had liver disease (cirrhosis) alone or HCC in the background of cirrhosis. The discovery set consisted of 360 patients from two independent locations. A logistic regression algorithm was developed that incorporated log-transformed AFP values with age, gender, alkaline phosphatase, and alanine aminotransferase levels. We define this as the Doylestown algorithm. In the discovery set, the Doylestown algorithm improved the overall performance of AFP by 10%. In subsequent external validation in over 2,700 patients from three independent sites, the Doylestown algorithm improved detection of HCC as compared with AFP alone by 4% to 20%. In addition, at a fixed specificity of 95%, the Doylestown algorithm improved the detection of HCC as compared with AFP alone by 2% to 20%. In conclusion, the Doylestown algorithm consolidates clinical laboratory values, with age and gender, which are each individually associated with HCC risk, into a single value that can be used for HCC risk assessment. As such, it should be applicable and useful to the medical community that manages those at risk for developing HCC. Cancer Prev Res; 9(2); 172–9. ©2015 AACR.

Data description and detailed statistical information regarding model development. Supplementary Table 1. Patient information on samples from the University of Michigan. Supplementary Table 2. Patient information on samples from HALT-C. Supplementary Table 3. Patient information on samples from EDRN. Supplementary Table 4. Patient information on samples from Thomas Jefferson University. Supplementary Table 5. Patient information on samples from the University of Texas Southwestern Medical Center. Supplementary Table 6. Odds ratios for each predictor in univariate and multivariate logistic regressions. Supplementary Table 7. Indices of goodness-of-fit and apparent validation of candidate logistic regression models. Supplementary Table 8. Performance of leave one out cross validation (LOOCV). Supplementary Table 9. Cross Validation of bootstrap method. Supplementary Table 10. AUCs and IDIs from 3-fold Cross-Validation. Supplementary Table 11. Summary statistics of Doylestown model. Supplementary Table 12. Comparison of logistic regression, classification and regression tree (CART) and conditional inference tree (CTREE). Supplementary Figure 1. The distribution of AFP in each data set by cases and controls: Supplementary Figure 2. Quartiles for AFP in the individual patient sets. Supplementary Figure 3. Histogram of predictions and observe occurrence proportion of HCC for the top 4 models.

Tolerance of Mycobacterium tuberculosis to antibiotics contributes to the long duration of tuberculosis (TB) treatment and the emergence of drug-resistant strains. M. tuberculosis drug tolerance is induced by nutrient restriction, but the genetic determinants that promote antibiotic tolerance triggered by nutrient limitation have not been comprehensively identified. Here, we show that M. tuberculosis requires production of the outer membrane lipid phthiocerol dimycocerosate (PDIM) to tolerate antibiotics under nutrient-limited conditions. We developed an arrayed transposon (Tn) mutant library in M. tuberculosis Erdman and used orthogonal pooling and transposon sequencing (Tn-seq) to map the locations of individual mutants in the library. We screened a subset of the library (~1,000 mutants) by Tn-seq and identified 32 and 102 Tn mutants with altered tolerance to antibiotics in stationary phase and phosphate-starved conditions, respectively. Two mutants recovered from the arrayed library, ppgK::Tn and clpS::Tn, showed increased susceptibility to two different drug combinations in both nutrient-limited conditions, but their phenotypes were not complemented by the Tn-disrupted gene. Whole genome sequencing revealed single nucleotide polymorphisms in both the ppgK::Tn and clpS::Tn mutants that prevented PDIM production. Complementation of the clpS::Tn ppsD Q291* mutant with ppsD restored PDIM production and antibiotic tolerance, demonstrating that loss of PDIM sensitized M. tuberculosis to antibiotics. Our data suggest that drugs targeting production of PDIM, a critical M. tuberculosis virulence determinant, have the potential to enhance the efficacy of existing antibiotics, thereby shortening TB treatment and limiting development of drug resistance.IMPORTANCEMycobacterium tuberculosis causes 10 million cases of active TB disease and over 1 million deaths worldwide each year. TB treatment is complex, requiring at least 6 months of therapy with a combination of antibiotics. One factor that contributes to the length of TB treatment is M. tuberculosis phenotypic antibiotic tolerance, which allows the bacteria to survive prolonged drug exposure even in the absence of genetic mutations causing drug resistance. Here we report a genetic screen to identify M. tuberculosis genes that promote drug tolerance during nutrient starvation. Our study revealed the outer membrane lipid phthiocerol dimycocerosate (PDIM) as a key determinant of M. tuberculosis antibiotic tolerance triggered by nutrient starvation. Our study implicates PDIM synthesis as a potential target for development of new TB drugs that would sensitize M. tuberculosis to existing antibiotics to shorten TB treatment.

Infection with hepatitis B virus (HBV) is the most common cause of chronic hepatitis and hepatocellular carcinoma in the world today despite the availability of an effective vaccine and antiviral therapies for some patients. The virus causes both acute and chronic infections. It is estimated that at least 350 million in the world today are chronically infected with HBV. The epidemiology of this viral infection has revealed effective strategies for prevention and control that may lead to future reductions in the burden of disease. Hepatitis D virus, also known as delta virus, is a defective virus that cannot establish or maintain infection except in the presence of HBV. While the global impact of HDV infection is less than that of HBV alone, its prevention and control represent unique challenges due to its unusual characteristics.

After treatment with in situ stabilization, slipped capital femoral epiphysis (SCFE) patients have variable degrees of deformity that can contribute to femoroacetabular impingement (FAI). To evaluate the severity of residual deformity most physicians currently use biplanar radiographs of an anteroposterior pelvis which profiles the lateral head-neck deformity and a frog lateral view which profiles the anterior head-neck deformity. However, the assessment of FAI morphology commonly relies on the 45-degree Dunn view to profile the anterolateral head-neck junction where FAI deformity is maximal. Therefore, the purpose of this study was to compare the magnitude of residual SCFE deformity detected on the frog lateral radiograph to the 45-degree Dunn radiograph.A retrospective review of radiographic images of 50 hips (47 patients) diagnosed with SCFE at a single academic institution from 2014 to 2018 was performed. The group included 25 hips evaluated postoperatively after fixation (Group 1) and 25 hips presenting with residual symptomatic SCFE deformity after previous pinning (Group 2). The alpha angle was assessed on both the 45-degree Dunn and frog lateral views for comparison. The modified Southwick slip angle was assessed on the frog lateral view only as a measure of SCFE severity.The Dunn view showed the maximal residual SCFE deformity as measured by the alpha angle in 88% (44/50) of cases. Overall, the mean alpha angle (70.7 degree vs. 60.1 degree, P0.001) was significantly larger on the Dunn view as compared with frog lateral. Subgroup analysis showed a larger alpha angle on Dunn view compared with frog lateral in both immediate postoperative and residual SCFE deformities as well: Group 1 (69.5 degree vs. 60.9 degree, P0.001) and Group 2 (71.9 degree vs. 59.3 degree, P0.001).In patients with SCFE, the maximal residual deformity of the proximal femur can typically be seen on the 45-degree Dunn view, rather than on the frog lateral view. Our findings suggest the 45-degree Dunn view may be beneficial part of the postoperative assessment of SCFEs to quantify the true maximal deformity present.Level IV.

The lack of a common patient-reported outcome metric used among the orthopaedic population is a problem that has been previously identified by the American Academy of Orthopaedic Surgeons. The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed by the National Institute of Health with the goal of creating a precise and efficient measurement tool for patient-reported symptoms, functioning, and health-related quality of life to be used in clinical research. A study summarizing its use in the pediatric orthopaedic population has not been previously performed.We performed a literature search of Ovid Medline, Embase, Scopus, and the Cochrane Central Register of Controlled Trials from 2010 to August 2021. There were 1961 unique citations included after the removal of 1756 duplicates. After initial screening, 183 studies were screened under full-text review leaving a final number of 51 studies included in this scoping review.Pediatric PROMIS studies were grouped by body part or sub-speciality: "Hand and Upper Extremity" (25.5%, n=13), "Sports" (23.5%, n=12), "Spine" (13.7%, n=7), "Trauma" (13.7%, n=7), "General Pediatric Orthopaedics" (11.8%, n=6), "Lower Extremity" (9.8%, n=5), and "Orthopaedic Oncology" (2%, n=1). An increase in studies utilizing PROMIS was seen throughout the study period with only 3 studies published from 2013 to 2016 to 39 in 2020 and 2021 alone. The 3 most frequently used pediatric PROMIS domains were Pain Interference (76.5%, n=39/51), Mobility (60.8%, n=31/51), and Upper Extremity (54.9%, n=28/51). 64.3% (n=9/14) of the included studies which reported on the floor effects of Pain Interference exhibited a significant floor effect. In all, 77.8% (n=7/9) of the included studies which reported on ceiling effects of Upper Extremity exhibited a significant ceiling effect.The use of PROMIS increased significantly since the first publication in 2013 suggesting orthopaedic providers have increasingly utilized PROMIS in their day-to-day practice as an outcome measure. Ceiling and floor effects were prominent in several of the included domains (Pain Interference and Upper Extremity). Overall, PROMIS measures are efficient, reliable, and effective to use.IV.

BACKGROUND Plain radiographic evaluation remains the standard initial assessment of patellar instability, while 3-dimensional imaging is obtained in some patients. Merchant radiographs can demonstrate the tibial tubercle relative to the trochlear groove (TT-TG), but the determination of the TT-TG from these radiographs has been abandoned since its original description. The purpose of this study is to evaluate the utility of the TT-TG measured on Merchant radiographs for the assessment of patellar instability. METHODS A prospective cohort study was performed of pediatric and adolescent patients aged 10 to 18 who underwent standardized Merchant radiographs, including a total of 98 knees (in 57 patients). Merchant TT-TG was measured as the distance between the center of the trochlear groove and the tibial tubercle, with both lines perpendicular to the anterior femoral condylar axis. In Part 1, the Merchant TT-TG measured by the tibial tubercle radiographic appearance was compared with the measurement utilizing a radiographic marker. In Part 2, the Merchant TT-TG was compared with the magnetic resonance imaging (MRI) TT-TG distance using bivariate linear regression analysis. TT-TG measurements were compared in patients with and without patellar instability with receiver operating characteristic curve analysis. RESULTS The tibial tubercle was identified on Merchant radiograph in 81.7% (67/82) of knees, and there was an excellent correlation (Pearson correlation coefficient=0.85) between the Merchant TT-TG and the measurement based on marker placement. Merchant TT-TG was on average 4.5 mm less than MRI TT-TG (12.8±4.4 vs. 8.4±7.7 mm, P

Pediatric sports medicine is a new and rapidly growing subspecialty within orthopaedic surgery. However, there is very limited literature on the practice of pediatric sports medicine in North America. Therefore, the purpose of this study was to evaluate and describe the current practice patterns of orthopaedic surgeons specializing in pediatric sports medicine.An online survey was distributed to orthopaedic surgeons specializing in pediatric sports medicine through the Pediatric Research in Sports Medicine Society. The purpose of the survey was to characterize (1) surgeon demographics, (2) the breakdown of different joint specialization, and (3) the specific procedures for joints that the surgeons specialize in.Responses from 55 orthopaedic surgeons were collected and analyzed. Most respondents considered pediatric sports medicine as the primary focus of their practice (89.1%, n=49/55). The number of fellowships completed was almost evenly split between either a single fellowship (52.7%, n=29/55) or 2 or more (47.3%, n=26/55). The most common combination of fellowships was pediatric orthopaedics and adult sports medicine (32.7%, n=18/55). Most survey respondents had been in practice for10 years (69.0%, n=38/55) and were affiliated with an academic center (61.8%, n=34/55). On average, 77.5% of the patients treated were18 years old. The knee joint was the most specialized joint, with 98.2% (n=54/55) respondents reporting that the knee joint constituted ≥25% of their practice. The knee joint constituted a mean of 52.1% of the respondents' overall practice, followed by the shoulder (15.2%), hip (13.9%), ankle (7.5%), elbow (7.1%), and wrist (4.2%).Pediatric sports medicine practices are variable and have distinct practice patterns in pediatric, orthopaedic, and adult sports practices. In the current study, most surgeons are less than 10 years into practice, affiliated with academic centers, and have typically completed either 1 or 2 fellowships after residency. Surgeons were most commonly specialized in the knee joint and cared for patients18 years old.Level of evidence IV.

Two-ion crystals constitute a platform for investigations of quantum nature that can be extended to any ion species or charged particle provided one of the ions in the crystal can be directly laser cooled and manipulated with laser radiation. This paper presents the formation of two-ion crystals for quantum metrology in a 7-tesla open-ring Penning trap. 40Ca+ ions are produced either internally by photoionization or externally in a (Paul-trap) source, transported through the strong magnetic field gradient of the superconducting solenoid, and captured in-flight with a mean kinetic energy of a few electronvolts with respect to the minimum of the Penning-trap potential well. Laser cooling of the two-ion crystal in a strong magnetic field towards reaching the quantum regime is also presented, with particular emphasis on the cooling of the radial modes., Spanish Government PID2019-104093GB-I00/AEI/10.013 39/501100011033, Andalusian Government P18FR-3432 PTA2018-016573-I, Fondo Operativo FEDER A-FQM-425-UGR18, Spanish Government FPU17/02596, University of Granada "Plan Propio -Programa de Intensificacion de la Investigacion" PP2017-PRI.I-04, Laboratorios Singulares 2020, European Research Council (ERC) European Commission 278648TRAPSENSOR MICINN/FEDER/UGR FPA2015-67694-P FPA2012-32076 UNGR10-1E501 UNGR13-1E-1830 EQC2018-005130-P, Junta de Andalucia, European Commission IE-5713 IE2017-5513, Spanish MICINN ("Beatriz Galindo" Fellowship) BEAGAL18/00078, German Research Foundation (DFG), European Commission SFB/CRC 1227

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death worldwide, and the cancer with the fastest increase in mortality in the United States, with more than 39,000 cases and 29,000 deaths in 2018. As with many cancers, survival is significantly improved by early detection. The median survival of patients with early HCC is >60 months but See all articles in this CEBP Focus section, “NCI Early Detection Research Network: Making Cancer Detection Possible.”

Study design Retrospective cohort. Objective To determine if the presence of diabetes mellitus as comorbidity is associated with complications, inpatient length of stay, or direct hospital costs after minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Summary of background data Very few studies have investigated the effect of diabetes on complications, length of stay, or costs in minimally invasive lumbar surgeries. Methods Patients undergoing primary, single-level MIS TLIF were retrospectively reviewed. Diabetic and nondiabetic patients were propensity matched in a 1:1 manner for age, sex, and comorbidity burden. An association between diabetic status and preoperative demographic or perioperative variables, including inpatient length of stay, was tested for using Student t test or χ analysis. Multivariate linear regression was used to test for an association between diabetic status and direct hospital costs. Results After 1:1 propensity matching, 100 patients were included in this analysis. There were no significant differences in age, sex, body mass index, smoking status, or Charlson Comorbidity Index between propensity-matched patients with and without diabetes. In regards to the length of stay, no significant differences existed between diabetic and nondiabetic groups (68.7 vs. 58.3 h, P=0.218). No other significant differences existed in other perioperative variables including operative time, intraoperative blood loss, or complication rate (P≥0.05 for each). Multivariate analysis indicated that diabetic status was not associated with differences in total direct hospital costs (US$20,428 vs. US$20,429, P=0.792) or cost subcategories after MIS TLIF (P≥0.05 for each). Conclusions In this investigation, diabetes was not associated with postoperative complication rates, inpatient length of stay, or direct hospital costs after primary, single-level MIS TLIF. The reduced extent of operative exposure and tissue trauma in MIS TLIF may mitigate the risk of complications in diabetic patients, possibly preventing extensions in hospital stay length and associated hospital costs.

Radiation therapy (RT) is often necessary for the treatment of head and neck cancers. Osteoradionecrosis (ORN) is a rare, but potentially serious complication of RT. RT leads to the destruction of vasculature in radiated tissue causing hypoxia and tissue necrosis. ORN can occur in any bone, but bones with naturally poor blood supply appear to be more susceptible. Bones of the skull base are susceptible, with ORN occurring in the anterior, central, and lateral skull base. Risk factors include cancer type and location, radiation dose, and a variety of patient factors. Patients often present with pain, bleeding, and foul odor and are typically found to have exposed and necrotic bone. Treatment options vary depending on the severity, but typically include pentoxifylline and vitamin E as well as surgical debridement, with less evidence supporting hyperbaric oxygen therapy. Recognition and prompt treatment of ORN will allow for improved patient outcomes.

STUDY DESIGN This was a systematic review. OBJECTIVE The objective of this study was to review radiographic, clinical, and surgical outcomes of expandable interbody device implantation following lumbar fusion. SUMMARY OF BACKGROUND DATA Few studies have evaluated postsurgical outcomes of expandable implants following lumbar interbody fusion. METHODS A systematic review was performed to identify studies investigating expandable intervertebral body devices in lumbar fusion. Radiographic parameters, fusion assessments, patient-reported outcomes (PROs), complications, and revision data were recorded. A comparison of expandable and static devices was performed using a meta-analysis. RESULTS Eleven articles were included. Postoperative improvements for each radiographic parameters for expandable versus static device implantation ranged from: lumbar lordosis, +2.0 to +5.0 degrees (expandable) versus +1.0 to +4.4 degrees (static); segmental lordosis, +1.0 to +5.2 degrees (expandable) versus+1.1 to +2.3 degrees (static); disk height, +0.82 to +4.8 mm (expandable) versus +0.26 to +6.9 mm (static); foraminal height, +0.13 to +2.8 mm (expandable) versus and +0.05 to +3.0 mm (static). Fusion rates ranged from 72.1% at 6 months to 100% at terminal follow-up. Preoperative to final follow-up improvement for the various PROs assessed were: Oswestry Disability Index, -15.4 to -56.3 (expandable) versus -13.6 to -26.3 (static); Visual Analog Scale (VAS) Back, -3.2 to -6.0 (expandable) versus -3.1 to -4.1 (static); and VAS Leg, -2.9 to -7.1 (expandable) -3.0 versus -4.8 (static). Static cages had a reported complication rate ranging from 6.0% to 16.1% and a subsidence rate of 6.0%. Expandable cages had a reported complication rate that ranged from 0.0.% to 10.0% and a subsidence rate of 5.5%-10.0%. A meta-analysis demonstrated a statistically significant difference in the PRO Oswestry Disability Index, but not VAS Back, VAS Leg, or radiographic outcomes (disk height or foraminal height). CONCLUSION There is no clear evidence for the use of expandable interbody devices over static devices.

Background Low-severity prescribed fire is an important tool to manage fire-maintained forests across North America. In dry conifer forests of the western USA, prescribed fire is often used to reduce fuel loads in forests characterized historically by mixed- and low-severity fire regimes. Understanding the ecological effects of prescribed fire treatments is important for predicting the impacts of these management actions on wildlife communities. Few studies, however, have estimated small landbird responses to forest treatments at spatial scales relevant to their ecology or have examined potential differences in treatment effects applied within historically mixed- vs. low-severity fire regimes. Therefore, we evaluated prescribed fire treatment effects and relationships with burn severity for avian communities in dry conifer forests dominated by ponderosa pine (Pinus ponderosa) located on seven national forests in the interior western USA. We surveyed birds for 1–4 years and 1–3 years before and after prescribed fire treatments at mixed- and low-severity fire regime locations, respectively, following a before-after, control-impact study design — 8 paired control-treatment units in mixed-severity locations (16 total study units with 320 survey points) and 4 paired control-treatment units in low-severity locations (10 total study units with 278 survey points). Using a Bayesian hierarchical multi-species occupancy model, we investigated responses to prescribed fire treatments by a community of 95 bird species. Results We found statistically supported treatment effects and/or burn severity relationships for 33 species primarily in mixed-severity locations. The data supported positive treatment effects at mixed-severity locations for 9 species (American robin [Turdus migratorius], western bluebird [Sialia mexicana], hairy woodpecker [Dryobates villosus], black-backed woodpecker [Picoides arcticus], American three-toed woodpecker [Picoides dorsalis], house wren [Troglodytes aedon], dusky flycatcher [Empidonax oberholseri], western wood-pewee [Contopus sordidulus], gray flycatcher [Empidonax wrightii]), whose occupancy was more likely after treatment at the most severely burned units, and a negative effect for one species (ruby-crowned kinglet [Corthylio calendula]), whose occupancy was less likely after treatment at the most severely burned units. At low-severity locations, only two species exhibited treatment effects, both negative (red-faced warbler [Cardellina rubrifrons] and lark sparrow [Chondestes grammacus]). We also found supported occupancy relationships with burn severity post-treatment (i.e., regardless of species distribution before treatment) for 29 species, most of which were consistent with their life histories (e.g., patterns of positive relationships for cavity-nesting, bark insectivores and negative relationships for open-nesting, foliage insectivores). Stronger responses to prescribed fire treatments at mixed-severity locations were unexpected because prescribed fire applications were more similar to historical wildfires characteristic of low-severity fire regimes. Conclusions Bird populations in historically low-severity locations may be relatively unresponsive to prescribed fire because fire there is typically more frequent and regular. By comparison, fire events in forests characterized by a mixed-severity regime are less common, potentially eliciting more responses to an infrequent opportunity, even by species that are strongly associated with recently burned forests by wildfire. Our results suggest that fire management activities intended to reduce fuels and lower the risk of high-severity wildfire can also be effective in creating habitat for some fire specialists at least in the short term.

Background This is a description of consecutive patients converted from ileal pouch-anal anastomosis (IPAA) to continent ileostomy (CI) at a tertiary centre, outcome after surgery and patient satisfaction after long time follow-up. Methods All consecutive patients operated with IPAA which later was converted to a CI at Sahlgrenska University Hospital, Gothenburg, Sweden, were included in the study. Demographic data was registered and a questionnaire regarding quality of life was sent to included patients. Results A total of 28 patients were included during the period of 1985-2022. The most common diagnosis was Ulcerative Colitis (UC) (n=23), other diagnoses included Crohn′s disease (n=2) and Familial Adenomatous Polyposis (n=1) (missing data n=2). IPAA was performed at a mean age of 30 (15-49) years and IPAA converted to CI at a mean age of 39 (22-62) years. At follow-up, three of the patients were diseased, not related to conversion surgery, and one had moved abroad. All of the remaining 24 patients completed the questionnaire. 20/28 (71%) patients still had their CI in function. 17/28 (61%) were converted due to fistula problems and the rest due to functional problems. 20/28 (71%) were converted using their IPAA-pouch and 4/28 (14%) had a new-constructed reservoir (missing data n=4). Totally, 18/20 (90% p Conclusion A CI is an alternative that patients seem to be satisfied with, even after long follow-up time, when IPAA is no longer a suitable alternative. The majority of the patients in this study were converted from IPAA to CI using their IPAA-pouch.

This paper contributes to increasing resource efficiency by providing a method for calculating the environmental impact in the context of the infrastructure sector. For this purpose, the LCA method is linked to a parametric BIM model for road construction. Municipal existing road structures and characteristics were considered for the development of the approach. The research topic is motivated by the sector of infrastructure construction and especially road construction, which is enormously resource-intensive. Therefore, resource efficiency indicators such as raw material consumption, energy consumption and climate warming must be adequately implemented in the information model for the entire life cycle of a road construction project. The aim of this work was to combine the two areas of resource efficiency calculation and parametric BIM modeling and to generate added value from this combination. In this way, relevant indicators can be extracted that can also be used to define the information needs in terms of resource efficiency and further developed as recommendations for municipal operators. The extension of the methodology to other infrastructure areas has been identified as a further starting point. In the future, it must be ensured that resource flows are recorded holistically to increase resource efficiency.

Chronic hepatitis B virus (HBV) infection is the leading cause of liver cirrhosis and hepatocellular carcinoma, estimated to be globally responsible for ∼800,000 deaths annually. Although effective vaccines are available to prevent new HBV infection, treatment of existing chronic hepatitis B (CHB) is limited, as the current standard-of-care antiviral drugs can only suppress viral replication without achieving cure. In 2016, the World Health Organization called for the elimination of viral hepatitis as a global public health threat by 2030. The United States and other nations are working to meet this ambitious goal by developing strategies to cure CHB, as well as prevent HBV transmission. This review considers recent research progress in understanding HBV pathobiology and development of therapeutics for the cure of CHB, which is necessary for elimination of hepatitis B by 2030.

PurposeThis study aimed to evaluate the clinical need for an automated decision-support software platform for adaptive radiation therapy (ART) of head and neck cancer (HNC) patients.MethodsWe tested RTapp (SegAna), a new ART software platform for deciding when a treatment replan is needed, to investigate a set of 27 HNC patients’ data retrospectively. For each fraction, the software estimated key components of ART such as daily dose distribution and cumulative doses received by targets and organs at risk (OARs) from daily 3D imaging in real-time. RTapp also included a prediction algorithm that analyzed dosimetric parameter (DP) trends against user-specified thresholds to proactively trigger adaptive re-planning up to four fractions ahead. The DPs evaluated for ART were based on treatment planning dose constraints. Warning (V959510) were set for all Dmax and Dmean DPs. Any threshold violation at end of treatment (EOT) triggered a review of the DP trends to determine the threshold-crossing fraction Fx when the violations occurred. The prediction model accuracy was determined as the difference between calculated and predicted DP values with 95% confidence intervals (CI95).ResultsRTapp was able to address the needs of treatment adaptation. Specifically, we identified 18/27 studies (67%) for violating PTV coverage or parotid Dmean at EOT. Twelve PTVs had V95Fx= 6 (range, 1–16). Seventeen parotids were flagged for exceeding Dmean dose constraints with a median increase of +2.60 Gy (range, 0.99–6.31 Gy) at EOT, including nine with DP>DE10. The differences between predicted and calculated PTV V95 and parotid Dmean was up to 7.6% (mean ± CI95, −2.7 ± 4.1%) and 5 Gy (mean ± CI95, 0.3 ± 1.6 Gy), respectively. The most accurate predictions were obtained closest to the threshold-crossing fraction. For parotids, the results showed that Fx ranged between fractions 1 and 23, with a lack of specific trend demonstrating that the need for treatment adaptation may be verified for every fraction.ConclusionIntegrated in an ART clinical workflow, RTapp aids in predicting whether specific treatment would require adaptation up to four fractions ahead of time.

Purpose: Currently, calculations of proton range in proton therapy patients are based on a conversion of CT Hounsfield Units of patient tissues into proton relative stopping power. Uncertainties in this conversion necessitate larger proximal and distal planned target volume margins. Proton CT can potentially reduce these uncertainties by directly measuring proton stopping power. We aim to demonstrate proton CT imaging with complex porcine samples, to analyze in detail three-dimensional regions of interest, and to compare proton stopping powers directly measured by proton CT to those determined from x-ray CT scans. Methods: We have used a prototype proton imaging system with single proton tracking to acquire proton radiography and proton CT images of a sample of porcine pectoral girdle and ribs, and a pig's head. We also acquired close in time x-ray CT scans of the same samples, and compared proton stopping power measurements from the two modalities. In the case of the pig's head, we obtained x-ray CT scans from two different scanners, and compared results from high-dose and low-dose settings. Results: Comparing our reconstructed proton CT images with images derived from x-ray CT scans, we find agreement within 1% to 2% for soft tissues, and discrepancies of up to 6% for compact bone. We also observed large discrepancies, up to 40%, for cavitated regions with mixed content of air, soft tissue, and bone, such as sinus cavities or tympanic bullae. Conclusions: Our images and findings from a clinically realistic proton CT scanner demonstrate the potential for proton CT to be used for low-dose treatment planning with reduced margins., Accepted for publication in Medical Physics

STUDY DESIGN A systematic review. OBJECTIVE The aim of this study was to determine the association between study outcomes and the presence of a conflict of interest (COI) in the lumbar disc arthroplasty (LDA) literature. SUMMARY OF BACKGROUND DATA Previous studies have evaluated the efficacy of LDA as a surgical alternative to arthrodesis. As investigators may have financial relationships with LDA device companies, it is important to consider the role of COI on study outcomes. METHODS A systematic review was performed to identify articles reporting clinical outcomes of LDA. Any financial COIs disclosed were recorded and confirmed through Open Payments and ProPublica databases. Study outcomes were graded as favorable, unfavorable, or equivocal. Pearson Chi-squared analysis was used to determine an association between COI and study outcomes. Favorable outcomes were tested for an association with study characteristics using Poisson regression with robust error variance. RESULTS Fifty-seven articles were included, 30 had a financial COI, while 27 did not. Ninety percent of the conflicted studies disclosed their COI in the article. Studies with United States authors were more likely to be conflicted (P = 0.019). A majority of studies reported favorable outcomes for LDA (n = 39). Conflicted studies were more likely to report favorable outcomes than nonconflicted studies (P = 0.020). Articles with COIs related to consultant fees (P = 0.003), research funding (P = 0.002), and stock ownership (P

This article discusses the creation of a new philosophical model of librarian-patron interaction. Directly influenced by the classical Indian text The Yoga Sutras of Patañjali, the authors have created the Triadic Model of Holistic Advocacy, which is supported by three yogic concepts: yoga (union), karuṇā (compassion), and āsana (pose). At its core, holistic advocacy encompasses both a philosophy and praxis of librarianship that is predicated on the belief that librarianship is fundamentally about service to others. Holistic advocacy requires a consistent, empathetic approach to librarian-patron interactions that is ultimately reflected in the quality of services rendered. The authors argue that engaging in holistic advocacy empowers library professionals to better advocate for patrons, specific libraries, and librarianship as a field. Embedding this ethos will help ensure that advocacy happens frequently and organically. Furthermore, holistic advocacy is a mindset that will help foster the growth of a more critically-thinking, compassionate society. The blending of eastern philosophical concepts (as outlined in the The Yoga Sutras of Patañjali) and western practices of LIS has not yet been discussed in the literature. The authors hope this discussion will encourage others to consider how eastern philosophy impacts western library practices.

Background Opioid overprescribing is a nationwide problem contributing to the current epidemic. This study evaluated opioid consumption, physician prescribing, and patient satisfaction with pain control following outpatient plastic surgery procedures. Methods Patients completed a questionnaire during their first postoperative visit. The authors queried about procedure type, quantity of opioids prescribed and consumed, days to opioid cessation, prescription refills, pain scores, use of nonopioid analgesics, and satisfaction with pain control. Results One hundred seventy patients were included. On average, 26 tablets were prescribed and 13 were consumed. Eighty percent of patients stopped opioids by postoperative day 5. Patients rated their worst pain at 6.1 and follow-up pain at 1.9. Approximately 50 percent of patients consumed nonopioid analgesics. Ninety-six percent of patients were satisfied with their pain control. Similar findings were observed across procedure subcategories. The number of pills prescribed was not correlated with satisfaction but was predictive of worst pain level (p = 0.014). Reduction mammaplasty and abdominoplasty patients consumed the most opioids at 17 and 18.6 pills, respectively; however, first-stage alloplastic breast reconstruction had the largest percentage of patients consuming opioids at the time of follow-up (25 percent) and requiring refills (7 percent). Patients who underwent revision of their reconstructed breast reported the earliest opioid cessation, rated their pain the lowest, and were prescribed the most excess tablets. Conclusions Plastic surgeons are prescribing almost double the amount of opioids consumed by patients after outpatient plastic surgery procedures. The results of this study may help guide prescribing practices.

The treatment of scoliosis has been explored and debated in medicine since the first recorded texts. Scoliosis treatment has shifted over time from external modalities, such as traction and bracing, to internal stabilization techniques that leverage surgical advances. Surgical fixation constructs can generally be separated into two different modalities: dynamic vs. static constructs. For skeletally immature individuals with progressive deformities, surgical options range from traditional or magnetically controlled growing rods to vertebral body staples or tethering. For individuals who have reached skeletal maturity, many devices have been developed that provide static length constructs. Understanding the surgical options available is critical for the appropriate management of this varied patient population. With this article, we sought to provide a summary of past and present techniques and devices used in the treatment of scoliosis.

Iminosugar glucosidase inhibitors prevent the folding of a range of viral N-linked glycoproteins, ranging from hepatitis B to Ebola. We recently showed they inhibit folding and function of the ACE2 protein, which is the receptor for SARS-CoV-2, and they have also inhibited the SARS Spike polypeptides. Here we report that the imino sugar glucosidase inhibitors, N-butyl deoxynojirimycin (NBDNJ), which is approved for management of lysosomal storage disease (sold as Zavesca), and ureido-N-hexyl deoxynojirimycine (BSBI-19029), suppress the replication of SARS-ncCoV-2/USA/WA1/2020 strain, in tissue culture. Moreover, combinations of either of these iminosugars with Remdesivir were particularly potent in suppressing SARS-CoV-2. Briefly, NBDNJ, 19029 and Remdesivir suppressed SARS-CoV-2 production in A549ACE2 human lung cells with IC90s of ~130 μM, ~4.0 μM, and 0.006 μM respectively. The combination of as little as 0.037 μM of NBDNJ or 0.04 μM 19029, respectively and 0.002 μM Remdesivir yielded IC90s. Medical strategies to manage SARS-CoV-2 infection of people are urgently needed, and although Remdesivir and Favipiravir have shown efficacy, it is limited. NBDNJ was recently reported by others to have tissue culture activity against SARS-CoV-2, so our report confirms this, and extends the findings to a more potent iminosugar, 19029 and combination with Remdesivir. Since both NBDNJ and Remdesivir are both approved and available for human use, the possibility that NBDNJ has mono therapeutic value against SARS-CoV-2 as well as can enhance Remdesivir, may have clinical implications, which are discussed, here.

Background Kock’s continent ileostomy is an option after proctocolectomy for patients not suitable for ileal pouch anal anastomosis or ileorectal anastomosis. Ulcerative colitis is the most common indication for continent ileostomy. The aim of this study was to evaluate the long-term outcome of continent ileostomy. Methods All patients with inflammatory bowel disease and a continent ileostomy were identified from the Swedish National Patient Register. Data on demographics, diagnosis, reoperations, and excisions of the continent ileostomy was obtained. Patients with inconsistent diagnostic coding were classified as IBD-unclassified. Results Some, 727 patients were identified, 428 (59%) with Ulcerative colitis, 45 (6%) with Crohn’s disease and, 254 (35%) with IBD-unclassified. After a median follow-up time of, 27 (IQR, 21–31) years, 191 (26%) patients had never had revisional surgery. Some, 1,484 reoperations were performed on, 536 (74%) patients, the median number of reoperations was, 1 (IQR, 0–3) per patient. The continent ileostomy was excised in, 77 (11%) patients. Reoperation within the first year after reconstruction was associated with higher rate of revisions (IRR, 2.90 p Conclusion Continent ileostomy is associated with substantial need for revisional surgery, but most patients get to keep their reconstruction for a long time.

[Image: see text] Chronic hepatitis B (CHB) is characterized by high levels of hepatitis B virus (HBV) surface antigen (HBsAg) in blood circulation. A major goal of CHB interventions is reducing or eliminating this antigenemia; however, there are currently no approved methods that can do this. A novel family of compounds with a dihydroquinolizinone (DHQ) scaffold has been shown to reduce circulating levels of HBsAg in animals, representing a first for a small molecule. Reductions of HBsAg were a result of the compound’s effect on HBsAg mRNA levels. However, commercial development by Roche of a DHQ lead compound, RG-7834, was stopped due to undisclosed toxicity issues. Herein we report our effort to convert the systemic RG7834 compound to a hepatoselective DHQ analog to limit its distribution to the bloodstream and thus to other body tissues.

Bilateral lambdoid and sagittal synostosis, or Mercedes Benz Syndrome, is a rare complex craniosynostosis resulting in frontal bossing, a tapered posterior fossa, and an anteriorly displaced cranial vertex. Its ideal surgical correction must result in posterior expansion, skull elongation, and caudal repositioning of the vertex. We present a craniometric analysis of skull changes with posterior-superior distraction and introduce a novel craniometric measure: vertex position. In this study, a retrospective review was performed to analyze outcomes of posterior cranial vault distraction osteogenesis (PVDO) using a posterior-superior distraction vector from 2016 to 2019. Cranial vertex position was measured as a fraction of the occipitofrontal diameter from rostral to caudal (0-1.0). Four patients underwent PVDO at mean age 10.61 ± 3.16 months utilizing a posterior-superior distraction vector. Linear distraction distance averaged 30.30 ± 0.90 mm with a mean consolidation period of 3.98 ± 0.72 months. Mean corrected change in intra-cranial volume was 236.30 ± 3.71 mL, at an average rate of 7.81 ± 2.00 mL/mm of distraction. Increases in anterior cranial height (7.83 ± 2.51 mm), middle cranial height (8.43 ± 4.21 mm), posterior cranial height (13.15 ± 7.45 mm), and posterior cranial fossa height (21.99 ± 8.55 mm) were observed. Cranial vertex demonstrated a mean posterior movement of 0.18 ± 0.13. PVDO utilizing a posterior-superior distraction vector for management of nonsyndromic bilateral lambdoid and sagittal synostosis effectively increases intracranial volume and height and provides an esthetic outcome with posterior movement of the cranial vertex.

Background: Avulsion fractures of the pelvis and hip are common injuries in adolescent patients. Avulsion sites include the rectus femoris at the anterior inferior iliac spine (AIIS), the sartorius at the anterior superior iliac spine (ASIS), the hamstrings at the ischial tuberosity, abdominal muscles on the iliac crest (IC), iliopsoas at the lesser trochanter (LT). Although these fractures are commonly treated conservatively, there is no consensus on the preferred treatment modality (conservative vs. surgical fixation) or thresholds for surgical treatment. The published literature is generally limited to small retrospective series, with in some cases conflicting results. Purpose: To summarize the available evidence on outcomes of pelvic and hip avulsion fractures in the pediatric and adolescent population using a systematic review of the literature. Study design: Systematic review. Methods: A systematic review of the literature was performed per PRISMA guidelines. Inclusion criteria included mean patient age of ≤18.0 years, ≥5 patients, avulsions treated with 3 months of injury, and publication in the English language. Patient characteristics, type of activity performed when injured, treatment modality, complications, and outcomes (rates of persistent symptoms, return to sport, subsequent surgery), were recorded by specific fracture type. Results: A total of 1034 patients with acute avulsion fractures from 23 studies were included. Of these, the outcomes were reported in 799 patients, including 693 (86.7%) who underwent conservative treatment and 106 (13.3%) who underwent surgical intervention. All types of acute avulsion fractures had good results with conservative treatment. Ischial tuberosity avulsions had the highest rate of persistent symptoms (25.4%) but only 10.2% underwent subsequent surgery. AIIS avulsions also had a high rate of persistent symptoms (19.3%) but very few underwent subsequent surgery (1.3%). Faster return to sport was noted in conservatively treated patients in ASIS and AIIS avulsions (both pConclusions: Both conservative treatment and surgical treatment of pelvic avulsion injuries appear to be effective for the majority of patients. Ischial tuberosity and AIIS avulsions have the highest rates of persistent symptoms at 25% and 19%, respectively. Further prospective research into all fracture types is needed to better define indications for surgery in a subgroup of patients. [Figure: see text]

Introduction: Anterior Cruciate Ligament Reconstruction (ACL-R) is increasingly common procedure performed in pediatric and adolescents. Patient-Reported Outcomes Measurements Information System (PROMIS) computer adaptive testing (CAT) has demonstrated to be a valid and reliable means to assess PROs in the pediatric population. Currently, all studies looking at the performance of PROMIS in the ACL-R population have utilized adult cohorts. Purpose: To characterize the recovery after pediatric ACL-R utilizing PROMIS including (1) changes in PROMIS domains during 1-year postoperative period and (2) to investigate if PROMIS scores can identify patients with early signs of arthrofibrosis at 6 weeks postoperatively and deficits in return to play testing at 6 months. Methods: Pediatric patients that underwent ACL-R were prospectively assessed with PROMIS at each clinical visit. PROMIS CAT domains included Mobility and Pain Interference. Inclusion criteria included patients 6 month PROMIS scores. Time points were as followed: baseline, 1 week, 1 month, 3 months, 6 months, and 1 year. Time points were compared utilizing a mixed-linear regression model. Significance was set at pResults: The study included 62 ACL-R with a mean age of 14.6±1.9 years. Patients demonstrated significant increases in Mobility and Pain Interference compared to pre-operative values by 3 months postoperatively and continued to significantly improve through 6 months (Figure 1 and 2). Significant improvements from 6 months to 1 year were not seen in either domain (all p>0.05). At 6 weeks postoperatively, 24% of patients had signs of early arthrofibrosis (none ultimately requiring surgical intervention). Significant differences in PROMIS Mobility (29.1 v. 35.1, p=0.001) were present between patients with and without early arthrofibrosis, while differences in Pain Interference were not significant (53.0 vs. 49.4, p=0.15). Patients with deficits on hop testing at return to play had lower PROMIS mobility (48.2 vs. 54.4, p=0.04) and higher PROMIS pain interference (38.9 vs. 33.8, p=0.02) than without deficits. Conclusions: PROMIS domains are easily obtained and demonstrate utility in monitoring pediatric patients after ACL-R including early signs of arthrofibrosis and deficits at return to play testing. [Figure: see text][Figure: see text]

Introduction: Patient-Reported Outcomes Measurements Information System (PROMIS) has been shown to be a valid and reliable means to assess patient-reported outcomes in athletes participating in orthopedic research and clinical care. PROMIS domains are separately validated in both pediatric (18 years) populations. However, the utilization of PROMIS in the adolescent athlete is complicated by the inability to convert between pediatric and adult PROMIS domains. Purpose: This study sought to establish conversion factors to transition between pediatric and adult values of the commonly tested PROMIS domains. Methods: This study consisted of 100 participants, aged 14-21 years old, who presented to orthopedic outpatient clinics with lower extremity complaints in various stages from initial presentation to postoperative recovery (excluding any within three months of surgery). All participants completed both adult and pediatric versions of the following PROMIS domains: Adult/Pediatric Mobility, Adult/Pediatric Pain Interference (PI), and Adult Physical Function (PF). Linear regression was utilized to determine a conversion factor between the two age groups within each domain by the mean difference. To evaluate the clinical significance of this difference, a 5-point threshold (representing minimally clinically important difference) between the two scores was set and 1-sided t-tests were performed. Results: Overall, 50 pediatric patients (mean age of 15.6 ± 1.1) and 50 young adult patients (18.9 ± 1.0) were included. Each group had roughly the same ratio of males to females (18:32 v. 17:33 for the pediatric and adult groups, respectively). Adult and Pediatric domains were all strongly correlated (range of r=0.85-0.87). In both groups, subjects scored higher on Adult domains than Pediatric domains (mean difference ranging from 4.2-6.3 points), all of which were significantly different (pConclusion: This study demonstrated that while Adult and Pediatric domains are highly correlated, over half of patients demonstrated clinically significant differences between scores. This study established correction factors to allow conversion between Pediatric and Adult PROMIS domains with high correlation.

Introduction: Anterior cruciate ligament reconstruction (ACL-R) is increasingly performed in pediatric patients. Infection after ACL-R is among the most serious complications. The use of administrative data has been validated for the assessment of infection after ACL reconstruction. While infection after ACL-R has been well investigated in adults, the literature is limited for ACL reconstruction in pediatric patients. Purpose: Describe and analyze the rates of infection after ACL-R among pediatric patients, compared to young adult patients, utilizing the MarketScan database. Methods: The Truven Health Analytics MarketScan Commercial Claims and Encounters database was assessed to access health care utilization data for privately insured individuals aged 5-30 years old. ACL-R records performed between 2006 and 2018 were obtained using Current Procedures Terminology (CPT) and International Classification of Diseases Ninth Revision (ICD-9) and Tenth (ICD-10) codes. The presence of postoperative infection requiring reoperation was assessed utilizing previously published algorithms. All patients had at least 180 days of insurance coverage after intervention. Results: The ACL-R cohort included 44,501 individuals under 18 years old and 53,915 individuals aged 18-30 years old. The rate of infection after ACL-R in patients under 18 years of age was 0.52%, and was similar to patients 18-30 years old (0.47%, p=0.213). Among patients Discussion: Utilizing an insurance database, this study demonstrated that rates of infection after an ACL-R are relatively low (0.52%) and are similar to rates in young adults, despite the differences in graft utilization. Both age less than 15 and female sex were associated slightly lower rates of infections in pediatric patients. [Figure: see text]

Introduction: Meniscal tears are commonly present in patients undergoing anterior cruciate ligament (ACL) reconstruction. Decision-making between meniscus repair and partial meniscectomy involves a number of factors from tear pattern to surgeon expertise and available technology. While meniscal and ACL tears in pediatric and adolescent patients are rising in incidence, changes in treatment of meniscus tears in the setting of ACL reconstruction have not been previously demonstrated. Purpose: To describe the trends of meniscal repair or meniscectomy in the setting of an ACL reconstruction among pediatric and adolescent patients utilizing the MarketScan Database from 2006 to 2018. Methods: The Truven Health Analytics MarketScan Commercial Claims and Encounters database was assessed to access health care utilization data for privately insured individuals younger than 18 years old. ACL reconstruction records performed between 2006 and 2018 were obtained using Current Procedures Terminology (CPT), and International Classification of Diseases Ninth Revision (ICD-9) and Tenth (ICD-10) codes. Inclusion criteria included at least 180 days of insurance coverage after intervention. Relative rates of MY and MR were compared by year in the mid-2000s (2006-2007) were compared to the late 2010s (2017-18) and were sub-stratified by age and estimated skeletal maturity. Results: A total of 44,501 patient under 18 years of age undergoing ACL reconstruction were identified. Meniscal tears were present in 57.0% of patients and treated with partial meniscectomy in 30.3% (n=13,482) and meniscal repair in 26.7% (n=11,884). Prevalence of meniscal injury in setting of ACL-R increased significantly with age, with a 19% increase from Conclusion: The current study demonstrates that at the time of ACL-R, meniscal pathology is common in pediatric patients. From 2006 to 2018, the rates of meniscal repair in the setting of ACL tears are steadily rising (32.8% to 51.8%) while partial meniscectomies are declining (67.2% to 48.2%), without an increase in early reoperation. [Figure: see text][Figure: see text]

Introduction: Patellar instability is a common problem in the active pediatric and adolescent population. Medial patellofemoral ligament (MPFL) reconstruction with or without associated tibial tubercle osteotomy (TTO) are the most commonly utilized surgical treatment. Patient-Reported Outcomes Measurements Information System (PROMIS) has been shown to be a valid and reliable means to assess patient-reported outcomes in the pediatric orthopedic population. Currently, little is known about the relative recovery of isolated MPFL reconstruction compared to MPFL reconstruction with combined TTO. Purpose: To assess the outcomes of patients undergoing an isolated MPFL Reconstruction or MPFL with TTO utilizing PROMIS during post-operative recovery period. Methods: Patients undergoing patellofemoral surgery were prospectively given PROMIS assessments at each clinical visit. Inclusion criteria included a diagnosis of patellar instability, no prior MPFL procedures, Results: A total of 58 patients were identified, 40 patients that underwent isolated MPFL and 18 patients that underwent MPFL + TTO. Both groups were relatively similar in terms of mean age (14.4 v. 15.3) and sex (62.5% v. 77.8% female). Changes in Mobility and Pain Interference were seen compared to baseline in both groups. For both Mobility and Pain interference, postoperative PROMIS changes were similar between isolated MPFL and MPFL + TTO groups (no significant differences at any timepoint) (Figure 1 and 2). Conclusions: MPFL reconstruction with or without TTO demonstrate improvements in PROMIS Mobility and Pain Interference after surgical treatment. The postoperative recovery of isolated MPFL reconstruction or MPFL reconstruction with TTO were very similar at all timepoints for PROMIS Mobility and Pain Interference. [Figure: see text][Figure: see text]