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The global demand for high energy density batteries, mostly for application in electric vehicles, offering increased durability, safety, and sustainability is growing rapidly. In the past, this demand has been met primarily by the development and/or improvement of new/established battery materials and technologies. The high-entropy design concept—aiming at increasing chemical complexity/occupational disorder—has recently been introduced into the field of electrochemical energy storage. Various high-entropy battery materials that are seemingly capable of outperforming low-entropy counterparts by offering desirable properties have been reported. However, future studies are required to explore if the concept is broadly applicable and can be extended to all types of battery materials, especially those that are of industrial relevance. Herein, we provide a brief overview of the existing high-entropy anodes, cathodes, and solid/liquid electrolytes for use in rechargeable Li- or Na-ion batteries and discuss potential research directions and opportunities. [ABSTRACT FROM AUTHOR]

The LUNGguard Organ Transport System (LG) is an FDA approved device for transporting donor lungs between 4°C - 8°C, mitigating freezing-related cellular and tissue injury. Given recent research on favorable recipient outcomes using LG, we theorized that LG may allow for time-shifting of procedures to the morning to optimize OR and transplant team logistics. The use of LUNGguard for this application in a real-world scenario was evaluated. Beginning April 2022, Houston Methodist Hospital began utilizing LG to extend cold ischemic time (CIT) to the morning hours to improve OR and transplant team logistics. This included preserving OR time for emergency cases and having full daytime staff available at the time of transplantation. At the time of this submission, a total of 10 cases were completed using LG at Houston Methodist Hospital. 7 of these cases utilized LG to shift the case to morning hours. Three time shift cases were double lung transplants (DLT). Three LG cases that were not time shifted were also DLT. Average total ischemic time in time shift cases was 469.4 minutes, and 329.7 minutes in non-time shift cases. Average temperature across time shift cases was 6.1°Celsius, and 5.5°Celsius in non-time shift cases. Average ICU length of stay (LOS) in time shift cases was 7.9 days as compared to 10.3 days in non-time shift cases. Total LOS was 22 days in time shift cases as compared to 65.5 days in the comparator group (not accounting for one patient death during index admission). Days to room air was 8 vs 11.5 days. No primary graft dysfunction (PGD) was diagnosed in cases using LG for time shifting. Our hypothesis that LG can be used to safely time shift cases to the morning hours appears to be supported with this initial evidence. No PGD was detected in time shift cases. ICU LOS, total LOS, time to liberation from oxygen were all found to be shorter in time shift cases. This includes comparing all time shift to non-time shift cases, as well as DLT time shift cases to DLT non-time shift cases. [ABSTRACT FROM AUTHOR]

We investigate the fusion cross-section and the fusion barrier distribution of OU at near- and sub-barrier energies. We use an interaction potential generated by the semi-microscopic double folding model-based on density dependent (DD) form of the realistic Michigan-three-Yukawa (M3Y) Reid nucleon-nucleon (NN) interaction. We studied the role of both the static and dynamic deformations of the target nucleus on the fusion process. Rotational and vibrational degrees of freedom of U-nucleus are considered. We found that the deformation and the octupole vibrations in U enhance its sub-barrier fusion cross-section. The signature of the the octupole vibrational modes of U appears clearly in its fusion barrier distribution profile. [ABSTRACT FROM AUTHOR]

The preformation probabilities of an cluster inside radioactive parent nuclei for both odd-even and odd-odd nuclei are investigated. The calculations cover the isotopic chains from Ir to Ac in the mass regions 1666AA215 and 777ZZ89. The calculations are employed in the framework of the density-dependent cluster model. A realistic density-dependent nucleon-nucleon (NN) interaction with a finite-range exchange part is used to calculate the microscopic -nucleus potential in the well-established double-folding model. The main effect of antisymmetrization under exchange of nucleons between the and daughter nuclei has been included in the folding model through the finite-range exchange part of the NN interaction. The calculated potential is then implemented to find both the assault frequency and the penetration probability of the particle by means of the Wentzel-Kramers-Brillouin approximation in combination with the Bohr-Sommerfeld quantization condition. The correlation of the -particle preformation probability and the neutron and proton level sequences of the parent nucleus as obtained in our previous work is extended to odd-even and odd-odd nuclei to determine the nuclear spin and parities. Two spin coupling rules are used, namely, strong and weak rules to determine the nuclear spin for odd-odd isotopes. This work can be a useful reference for theoretical calculation of undetermined nuclear spin of odd-odd nuclei in the future. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective cohort study., Objectives: Atypical hangman's fractures are associated with increased risk for neurologic injury due to involvement of the posterior cortex of the axis body. We present the largest single-center cohort of atypical hangman's fractures with the goal of guiding treatment decisions and outcomes based on fracture classification., Methods: We performed a retrospective analysis of all patients with atypical hangman's fractures treated at a single Level I trauma center between January 2010 and September 2023. 51 patients met inclusion criteria and demographic, treatment, and radiographic data were recorded and compared across the Type I and II fracture groups., Results: Final treatment modalities varied significantly between the groups ( P < 0.01), with hard cervical collar and invasive halo immobilization being the most prevalent treatments for fracture Types I and II respectively. One Type I fracture patient and four Type II fracture patients failed non-operative treatment, requiring surgery. Across both groups, posterior cervical fusion (73%) was the most common surgical approach. Median length of stay varied significantly between the two fracture groups (2.0 (1.0-7.0) vs 5.0 (3.0-8.0) days; P = 0.01). Irrespective of fracture type, longer hospital length of stay was associated with increased patient age (IRR = 1.02; P < 0.01), non-white race (IRR = 2.47; P = 0.01), injury caused by MVC (IRR = 1.93; P < 0.01), and the presence of non-spine orthopedic injuries (IRR = 1.72; P = 0.03)., Conclusions: While atypical Type I hangman's fractures may be managed effectively non-operatively with a hard cervical collar, atypical Type II fractures managed with a hard cervical collar are at greater risk of requiring subsequent surgical intervention., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: It is unclear how changes to the 2023-2024 Electronic Residency Application Service (ERAS) application will impact future applicants. We investigate students' perceptions about applying to residency during this transition period., Methods: An anonymous electronic survey was sent to medical students through social media of a women's surgical society. Questions reflected aspects of the ERAS application., Results: There were 415 responses, with 68 ​% planning to apply into surgical specialties (SS) and 17 ​% into non-surgical specialties (NSS). Compared with the NSS group, SS students reported decreased confidence in successfully matching, less attainable applicant expectations, and increased personal sacrifices to pursue their residency of interest. Students interested in Plastic and Reconstructive Surgery (PRS) placed 3-times more importance on the number of publications than General Surgery students. Away rotations were rated significantly more important for Otolaryngology, Orthopaedic, and PRS students., Conclusion: Students applying into surgical residencies experience unique stressors. Values among SS students differed across surgical subspecialties in preparation for the match. Further investigation characterizing the relationship between these values and characteristics of successful resident applicants is warranted., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose. This manuscript was written without the use of AI technology., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Solid oxide fuel cells (SOFCs) are paving the way to clean energy conversion, relying on efficient oxygen-ion conductors with high ionic conductivity coupled with a negligible electronic contribution. Doped rare earth aluminates are promising candidates for SOFC electrolytes due to their high ionic conductivity. However, they often suffer from p-type electronic conductivity at operating temperatures above 500 °C under oxidizing conditions caused by the incorporation of oxygen into the lattice. High entropy materials are a new class of materials conceptualized to be stable at higher temperatures due to their high configurational entropy. Introducing this concept to rare earth aluminates can be a promising approach to stabilize the lattice by shifting the stoichiometric point of the oxides to higher oxygen activities, and thereby, reducing the p-type electronic conductivity in the relevant oxygen partial pressure range. In this study, the high entropy oxide (Gd,La,Nd,Pr,Sm)AlO 3 is synthesized and doped with Ca. The Ca-doped (Gd,La,Nd,Pr,Sm)AlO 3 compounds exhibit a higher ionic conductivity than most of the corresponding Ca-doped rare earth aluminates accompanied by a reduction of the p-type electronic conductivity contribution typically observed under oxidizing conditions. In light of these findings, this study introduces high entropy aluminates as a promising candidate for SOFC electrolytes., (© 2024 The Authors. Small published by Wiley‐VCH GmbH.)

Histopathological assessment of esophageal biopsies is a key part in the management of patients with Barrett esophagus (BE) but prone to observer variability and reliable diagnostic methods are needed. Artificial intelligence (AI) is emerging as a powerful tool for aided diagnosis but often relies on abstract test and validation sets while real-world behavior is unknown. In this study, we developed a 2-stage AI system for histopathological assessment of BE-related dysplasia using deep learning to enhance the efficiency and accuracy of the pathology workflow. The AI system was developed and trained on 290 whole-slide images (WSIs) that were annotated at glandular and tissue levels. The system was designed to identify individual glands, grade dysplasia, and assign a WSI-level diagnosis. The proposed method was evaluated by comparing the performance of our AI system with that of a large international and heterogeneous group of 55 gastrointestinal pathologists assessing 55 digitized biopsies spanning the complete spectrum of BE-related dysplasia. The AI system correctly graded 76.4% of the WSIs, surpassing the performance of 53 out of the 55 participating pathologists. Furthermore, the receiver-operating characteristic analysis showed that the system's ability to predict the absence (nondysplastic BE) versus the presence of any dysplasia was with an area under the curve of 0.94 and a sensitivity of 0.92 at a specificity of 0.94. These findings demonstrate that this AI system has the potential to assist pathologists in assessment of BE-related dysplasia. The system's outputs could provide a reliable and consistent secondary diagnosis in challenging cases or be used for triaging low-risk nondysplastic biopsies, thereby reducing the workload of pathologists and increasing throughput., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Cutibacterium acnes, part of normal skin flora, is increasingly recognized as an opportunistic pathogen capable of causing chronic prosthetic joint infections (PJI) associated with total hip and knee arthroplasty. However, there is a paucity of literature examining the pathogenesis of C. acnes during PJI. To study this, we developed an implant-associated osteomyelitis murine model in which 8-10-week-old C57BL6 mice were subjected to transtibial implantation of titanium or stainless-steel L-shaped pins contaminated with C. acnes. Postsurgery, mice were killed on Days 14 and 28 for terminal assessments of (1) bacterial load in bone, implant, and internal organs (heart, spleen, kidney, and liver), (2) bone osteolysis (micro-CT), (3) abscess formation (histology), and (4) systematic electron microscopy (EM). In vitro scanning EM (SEM) confirmed that C. acnes can form biofilms on stainless-steel and titanium implants. In mice, C. acnes could persist for 28 days in the tibia. Also, we observed C. acnes dissemination to internal organs. C. acnes chronic osteomyelitis revealed markedly reduced bone osteolysis and abscess formation compared to Staphylococcus aureus infections. Importantly, transmission EM (TEM) investigation revealed the presence of C. acnes within canaliculi, demonstrating that C. acnes can invade the osteocyte lacuno-canalicular networks (OLCN) within bone. Our preliminary pilot study, for the first time, revealed that the OLCN in bone can be a reservoir for C. acnes and potentially provides a novel mechanism of why C. acnes chronic implant-associated bone infections are difficult to treat., (© 2024 Orthopaedic Research Society.)

Background Surgical site infection (SSI) following spine tumor surgery results in delays in radiation therapy and the initiation of systemic treatment. The study aims to assess risk factors for SSI in malignancy-related spinal infections and rates of infection observed in a single center with the use of betadine irrigation (BI) and intrawound vancomycin powder (IVP).  Methods Spine tumor patients managed from 11/2012 to 11/2023 were identified using a surgical database (JotLogs, Efficient Surgical Apps, Portland, Maine). Inclusion criteria were patients receiving BI and IVP and alive at 30 days post-op. Exclusion criteria were patients not receiving a combination of BI and IVP due to allergies and mortality within 30 days of surgery. Patient demographics, histology, history of pre-operative and post-operative radiation treatment history, tumor location, procedure type, number of procedures per patient, SSI, wound culture results, and mortality were collected. Results One hundred two patients undergoing 130 procedures had an SSI rate of 3.85% (5/130). There were 18.6% primary and 81.4% metastatic tumors. Demographics were average age 59.5 years old (range 7-92), 60.8% male, 39.2% female, White 88.2%, Black 9.8%, and others 2%. Pre-operative radiation therapy was significantly associated with the risk of SSI (p=0.005). Percutaneous instrumentation did not lead to a significant difference in infection rates (p=0.139). There was no significant difference in infection rates between primary and metastatic tumors (p=0.58). Multivariable regression analysis revealed pre-operative radiation (OR: 18.1; 95%CI: 1.9-172.7; p=0.009) as the statistically significant independent risk factor. Conclusions Pre-operative radiation therapy remains a risk factor for SSI. However, percutaneous instrumentation did not lead to SSI, and there was no significant difference in infection rates between primary and metastatic tumors. SSI rate was 3.85% in patients who had a combination of BI and IVP in spine tumor surgery., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. University of Rochester Medical Center and MedStar Washington Hospital Center issued approval STUDY00000497 and STUDY00008070. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mesfin et al.)

Background: Retraction of scientific publications is an important check on scientific misconduct and serves to maintain the integrity of the scientific literature. The present study aims to examine the prevalence, trends, and characteristics of retracted spine literature across basic science and clinical spine literature., Methods: Multiple databases were queried for retracted papers relating to spine or spine surgery, between January 2000 and May 2023. Of 112,668 publications initially identified, 125 were ultimately included in the present study following screening by 2 independent reviewers. Journal of origin, reasons for retraction, date of publication, date of retraction, impact factor of journal, countries of research origin, and study design were collected for each included publication., Results: Clinical studies were the most frequent type of retracted publication (n = 70). The most common reason for retraction was fraud (n = 58), followed by plagiarism (n = 22), and peer review process manipulation (n = 16). Impact factors ranged from 0.3 to 11.1 with a median of 3.75. Average months from publication to retraction across all studies was 37.5 months. The higher the journal impact factor, the longer the amount of time between publication and retraction (P = 0.01). China (n = 63) was the country of origin of more than half of all retracted spine publications., Conclusions: The rate of retractions has been increasing over the past 23 years, and clinical studies have been the most frequently retracted publication type. Clinicians treating disorders of the spine should be aware of these trends when relying on the clinical literature to inform their practice., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Aim: To assess the feasibility of Diabetic Foot Care Group (DFCG), a social media-based self-management education and support intervention, for people with diabetes (PWD) empowerment in diabetes-related foot ulceration prevention., Methods: A partially randomized preference trial was conducted among 32 PWD. DFCG was implemented through Facebook. Participants in the intervention group joined the DFCG in addition to their usual care, while the control group received usual care. Data were collected online using questionnaires on participants' DFCG acceptance, engagement and preliminary efficacy on nine diabetes foot care-related outcomes at baseline, one, and three months post-intervention., Results: The participants' study intervention acceptability and engagement rates were 84.2% and 55.2%, respectively. DFCG efficacy rate compared to usual care was 88.9% to 22.2%. Three diabetes foot care-related outcomes increased significantly in the intervention group three-month post-intervention: foot self-care adherence ( p  = 0.001, η p 2  = 0.35), preventive foot self-care practice ( p  = 0.002, η p 2  = 0.33), and physical health status ( p  < 0.02, η p 2  = 0.23)., Conclusion: DFCG is feasible and could effectively improve diabetes foot care-related outcomes., Innovation: Social media is an innovative approach healthcare professionals could utilize to virtually support PWD in ongoing learning and engagement in optimal foot self-care activities., Trial Registration: ClinicalTrials.gov, Identifier: NCT04395521., Competing Interests: The authors declare that they have no affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter discussed in this manuscript., (© 2024 The Authors. Published by Elsevier B.V.)

Introduction: Division chiefs play crucial leadership, administrative, and instructive roles within orthopedic subspecialties. The purpose of this study is to investigate the demographic and academic characteristics of division chiefs of adult reconstruction at fellowship institutions in the United States., Methods: Adult reconstruction fellowship programs were identified using the American Association of Hip and Knee Surgeons database. Characteristic information about sex, race, academic rank, additional degrees, fellowship institution, and year of completion were collected. Hirsch indices (h-indices) of the division chiefs were collected from the Scopus database., Results: Of the 120 adult reconstruction fellowship programs identified, 39 had a designated division chief of adult reconstruction. All of the division chiefs were male (n=39). Race breakdown was as follows: 74.4% were White (n=29), 12.8% were Asian (n=5), 7.7% were of mixed ethnicity (n=3), 2.6% were Latinx (n=1), and 2.6% were African American (n=1). The majority (53.8%; n=21) of division chiefs also held the academic rank of professor. The mean time since completion of fellowship was 21.7 ± 8.2 years and the mean h-index of the division chiefs was 24.9 ± 16.2. The fellowship programs that trained the most division chiefs were Massachusetts General Hospital (n=9) and the Hospital for Special Surgery (n=6)., Discussion: Division chiefs of adult reconstruction are integral leaders within their orthopedic subspecialty. An analysis of demographic and educational characteristics revealed a lack of diversity among adult reconstruction division chiefs in the United States. Deliberate efforts to increase the diversity of adult reconstruction leadership must be made to address these disparities., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Punreddy et al.)

Background: Various studies regarding retractions of publications have determined the rate of retraction has increased in recent years. Although this trend may apply to any field, there is a paucity of literature exploring the publication of erroneous studies within plastic and reconstructive surgery. The present study aims to identify trends in frequency and reasons for retraction of plastic and reconstructive surgery studies, with analysis of subspecialty and journals., Methods: A database search was conducted for retracted papers within plastic and reconstructive surgery. The initial search yielded 2347 results, which were analyzed by two independent reviewers. 77 studies were jointly identified for data collection., Results: The most common reasons for retractions were duplication (n = 20, 25.9 %), request of author (n = 15, 19.5 %), plagiarism (n = 9, 11.6 %), error (n = 9, 11.6 %), fraud (n = 2, 2.6 %), and conflict of interest (n = 1, 1.3 %). 15 were basic science studies (19.4 %), 58 were clinical science studies (75.3 %), and 4 were not categorized (5.2 %). Subspecialties of retracted papers were maxillofacial (n = 29, 37.7 %), reconstructive (n = 17, 22.0 %), wound healing (n = 8, 10.4 %), burn (n = 6, 7.8 %), esthetics (n = 5, 6.5 %), breast (n = 3, 3.9 %), and trauma (n = 1, 1.3 %). Mean impact factor was 2.9 and average time from publication to retraction was 32 months., Conclusion: Analysis of retracted plastic surgery studies revealed a recent rise in frequency of retractions, spanning a wide spectrum of journals and subspecialties., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objective: The objective of the systematic review is to examine and summarise the available evidence in the literature of the use of key performance indicators (KPIs) to inform evaluation of wound care programmes and services for people with hard-to-heal (complex) wounds. The need for wound care is expected to grow with the continued ageing of the population and the resulting increased development of chronic conditions. This expected increase necessitates improvement of wound care programmes and services and their ability to deliver quality, evidence-based and cost-effective practice. The current literature lacks a systematic assessment of KPIs to inform evaluation of wound care services and programmes across various settings, and how the KPIs are used to improve the quality of wound care and achieve desired outcomes. This protocol sets out how the systemtic review will be undertaken., Method: Primary studies will be screened from databases such as MEDLINE, CINAHL and Scopus, with unpublished studies and grey literature retrieved from Google Scholar and ProQuest Dissertations and Theses. The study titles and abstracts will be screened by two independent reviewers, using Covidence systematic review software to ensure they meet the inclusion criteria, who will then proceed with data extraction of the full-text using the standardised data extraction instrument. The reference lists of all studies selected for critical appraisal will be screened for additional publications. The two independent reviewers will critically appraise all studies undergoing full-text data extraction using the appropriate checklist from JBI SUMARI. At all stages, differences between reviewers will be resolved through discussion, with adjudication by a third, independent reviewer., Results: Data points will be analysed with descriptive statistics and grouped, based on programme characteristics and publication status. Grey literature and peer-reviewed publications will form separate analyses. To answer review questions, the data will be summarised in a narrative format. A meta-analysis is not planned. At the time of writing, this protocol has been implemented up to the preliminary literature search., Conclusion: This review will address a current literature gap and systematically identify KPIs in wound care, allowing for programmes to evaluate their quality of care and improve their services in a methodical manner.

Introduction: A tibial fracture is an uncommon, yet severe injury that occurs in professional athletes within all major sports leagues. These injuries are often debilitating for professional athletes and can require extensive rehabilitation prior to returning to play. The purpose of this study is to investigate the impact of a tibial fracture on athletic performance in all four major United States sports leagues., Methods: A publicly available professional sports database, Pro Sports Transactions, was queried for tibial injuries from January 01, 2015, to May 31, 2023. The search included all four major U.S. sports leagues. To quantify and compare athletic ability before and after injury, performance-based statistics were collected from standardized player ratings in periods surrounding the date of injury. The percent change in player performance was measured and stratified. The Pearson correlation test was used to analyze player demographics., Results: There were a total of 24 professional athletes who suffered 28 confirmed tibial fractures across all leagues. Upon return, there was a 14.7% decrease in overall player performance across all leagues. National Basketball Association, National Football League, and National Hockey League athletes had a decrease of 34.5%, 29.1%, and 14.2%, respectively, following their return to play. Major League Baseball players demonstrated an 8.1% increase in player performance following their recovery from tibial fracture., Conclusion: Players who suffer tibial fractures often undergo immediate surgery and, in unfortunate cases, may require multiple subsequent procedures. Additionally, athletes spend several months recovering prior to their return. Upon return, athletes' performance may be decreased; however, further study is required to strengthen the association between player performance and tibial fracture recovery., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Punreddy et al.)

Objective: Severity for pectus excavatum includes Haller index (HI) > 3.25. An extremely high HI (≥8) may influence surgical approach and complications. This study reviews outcomes of patients with high HI after repair., Methods: A single institution retrospective analysis was performed on adult patients with HI ≥ 8 undergoing pectus excavatum repairs. For outcomes, a propensity score-matched control group with a HI ≤ 4 was utilized., Results: In total, 64 cases (mean age, 33.5 ± 10.9 years; HI, 13.1 ± 5.0; 56% women) were included. A minimally invasive repair was successful in 84%. A hybrid procedure was performed in the remaining either to repair fractures of the ribs (8 patients) and sternum (5 patients) or when osteotomy and/or cartilage resection was required (10 patients). In comparison with the matched cohort (HI ≤ 4), patients with high HI had longer operative times (171 vs 133 minutes; P < .001), more frequently required hybrid procedures (16% vs 2%; P = .005), experienced higher incidences of rib (22% vs 3%; P = .001) and sternal fractures (12% vs 0%; P = .003), and had increased repair with 3 bars (50% vs 19%; P < .001). There were no significant differences between the groups for length of hospital stay or postoperative 30-day complications., Conclusions: Patients with an extremely high HI can be challenging cases with greater risks of fracture and need for osteotomy/cartilage resection. Despite this, minimally invasive repair techniques can be utilized in most cases without increased complications when performed by an experienced surgeon., Competing Interests: Conflict of Interest Statement Dr Jaroszewski discloses consulting and IP/royalties through Mayo Clinic Ventures with Zimmer Biomet Inc. All other authors reported no conflict of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest., (Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Obesity is considered a modifiable risk factor prior to total knee arthroplasty (TKA); however, little data support this hypothesis. Our purpose was to evaluate patients who have a body mass index (BMI) >40 presenting for TKA to determine the incidence of: (1) patients who achieved successful weight loss through nutritional modification or bariatric surgery and (2) patients who underwent TKA over the study period without the presence of a formal optimization program., Methods: This was a retrospective, single-center analysis. Inclusion criteria included: Kellgren and Lawrence grade 3 or 4 knee osteoarthritis, BMI >40 at presentation, and minimum 1-year follow-up (mean 45 months) (N = 624 patients). Demographics, weight loss interventions, pursuit of TKA, maximum BMI change, and Patient-Reported Outcomes Measurement Information System scores were collected. Multivariable logistic and linear regressions evaluated associations of underlying demographic and treatment characteristics with outcomes., Results: There were 11% of patients who ended up pursuing TKA over the study period. Bariatric surgery was 3.7 times more likely to decrease BMI by minimum 10 compared to nonsurgical intervention (95% confidence interval [CI] [1.7, 8.1]; P = .001). Bariatric surgery resulted in mean BMI change of -3.3 (range, 0 to 22) compared to nonsurgical interventions (-2.6 [range, 0 to 12]) and no intervention (0.4 [range, 0 to 15]; P < .0001). Bariatric surgery patients were 3.1 times more likely to undergo TKA (95% CI [1.3, 7.1]; P = .008), and nonsurgical interventions were 2.4 times more likely to undergo TKA (95% CI [1.3, 4.5]; P = .006) compared to no intervention. Non-White patients across all interventions were less likely to experience loss >5 BMI compared to White patients (95% CI [0.2, 0.9]; P = .018)., Conclusions: Most patients were unable to reduce BMI more than 5 to 10 over a mean 4-year period without a formal weight optimization program. Utilization of bariatric surgery was most successful compared to nonsurgical interventions, although ultimate pursuit of TKA remained low in all cohorts., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Musculoskeletal infections (MSKI), which are a major problem in orthopedics, occur when the pathogen eludes or overwhelms the host immune system. While effective vaccines and immunotherapies to prevent and treat MSKI should be possible, fundamental knowledge gaps in our understanding of protective, nonprotective, and pathogenic host immunity are prohibitive. We also lack critical knowledge of how host immunity is affected by the microbiome, implants, prior infection, nutrition, antibiotics, and concomitant therapies, autoimmunity, and other comorbidities. To define our current knowledge of these critical topics, a Host Immunity Section of the 2023 Orthopaedic Research Society MSKI International Consensus Meeting (ICM) proposed 78 questions. Systematic reviews were performed on 15 of these questions, upon which recommendations with level of evidence were voted on by the 72 ICM delegates, and another 12 questions were voted on with a recommendation of "Unknown" without systematic reviews. Two questions were transferred to another ICM Section, and the other 45 were tabled for future consideration due to limitations of available human resources. Here we report the results of the voting with internet access to the questions, recommendations, and rationale from the systematic reviews. Eighteen questions received a consensus vote of ≥90%, while nine recommendations failed to achieve this threshold. Commentary on why consensus was not achieved on these questions and potential ways forward are provided to stimulate specific funding mechanisms and research on these critical MSKI host defense questions., (© 2023 Orthopaedic Research Society.)