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Background: Utilization in outpatient total shoulder arthroplasties (TSAs) has increased significantly in recent years. It remains largely unknown whether utilization of outpatient TSA differs across gender and racial groups. This study aimed to quantify racial and gender disparities both nationally and by geographic regions., Methods: 168,504 TSAs were identified using Medicare fee-for-service inpatient and outpatient claims data and beneficiary enrollment data from 2020 to 2022Q4. The percentage of outpatient cases, defined as cases discharged on the same day of surgery, was evaluated by racial and gender groups and by different census divisions. A multivariate logistics regression model controlling for patient sociodemographic information (White vs. non-White race, age, gender, and dual eligibility for both Medicare and Medicaid), hierarchical condition category (HCC) score, hospital characteristics, year fixed effects, and patient residency state fixed effects was performed., Results: The TSA volume per 1000 beneficiaries was 2.3 for the White population compared with 0.8, 0.6, and 0.3 for the Black, Hispanic, and Asian population, respectively. A higher percentage of outpatient TSAs were in White patients (25.6%) compared with Black patients (20.4%) (P < .001). The Black TSA patients were also younger, more likely to be female, more likely to be dually eligible for Medicaid, and had higher HCC risk scores. After controlling for patient sociodemographic characteristics and hospital characteristics, the odds of receiving outpatient TSAs were 30% less for Black than the White group (odds ratio 0.70). Variations were observed across different census divisions, with South Atlantic (0.67, P < .01), East North Central (0.56, P < .001), and Middle Atlantic (0.36, P < .01) being the 4 regions observed with significant racial disparities. Statistically significant gender disparities were also found nationally and across regions, with an overall odds ratio of 0.75 (P < .001)., Discussion: Statistically significant racial and gender disparities were found nationally in outpatient TSAs, with Black patients having 30% (P < .001) fewer odds of receiving outpatient TSAs than White patients, and female patients with 25% (P < .001) fewer odds than male patients. Racial and gender disparities continue to be an issue for shoulder arthroplasties after the adoption of outpatient TSAs., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Ovarian cancer treatment includes cytoreductive surgery, platinum-based chemotherapy, and often poly (ADP-ribose) polymerase (PARP) inhibitors. Homologous recombination (HR)-deficiency is a well-established predictor of therapy sensitivity. However, over 50% of HR-proficient tumors also exhibit sensitivity to standard-of-care treatments. Currently, there are no biomarkers to identify which HR-proficient tumors will be sensitive to standard-of-care therapy. Replication stress may serve as a key determinant of response., Methods: We evaluated phospho-RPA2-T21 (pRPA2) foci via immunofluorescence as a potential biomarker of replication stress in formalin-fixed, paraffin-embedded tumor samples collected at diagnosis from patients treated with platinum chemotherapy (discovery cohort: n = 31, validation cohort: n = 244) or PARP inhibitors (n = 87). Recurrent tumors (n = 37) were also analyzed. pRPA2 scores were calculated using automated imaging analysis. Samples were defined as pRPA2-High if > 16% of cells had ≥ 2 pRPA2 foci., Results: In the discovery cohort, HR-proficient, pRPA2-High tumors demonstrated significantly higher rates of pathologic complete response to platinum chemotherapy than HR-proficient, pRPA2-Low tumors. In the validation cohort, patients with HR-proficient, pRPA2-High tumors had significantly longer survival after platinum treatment than those with HR-proficient, pRPA2-Low tumors. Additionally, the pRPA2 assay effectively predicted survival outcomes in patients treated with PARP inhibitors and in recurrent tumor samples., Conclusion: Our study underscores the importance of considering replication stress markers alongside HR status in therapeutic planning. Our work suggest that this assay could be used throughout a patient's treatment course to expand the number of patients receiving effective therapy while reducing unnecessary toxicity.

Objectives: Tissue banking procedures have evolved to keep pace with precision medicine, technology, emerging understanding of racial disparities, and regulatory requirements. However, there is little published guidance regarding strategies to create and maintain a successful biorepository. Our objective is to describe the infrastructure and protocols used by our Gynecologic Oncology Tissue Bank., Methods: Our Tissue Bank was founded in 1992. In August 2022, internal funding was used to modernize the Tissue Bank. We hired three full-time employees, implemented universal screening of patients treated by gynecologic oncology faculty, updated consenting protocols, and standardized communication with providers. Tumor tissue, blood derivatives, ascites, and pleural fluid were collected from eligible, consenting patients and processed. Patient-derived cell lines and organoids were generated. For quality control purposes, one formalin-fixed, paraffin-embedded (FFPE) sample per tissue site was analyzed by a board-certified pathologist. All samples were labeled and tracked in an OpenSpecimen collection protocol and clinically annotated in a secure database., Results: From August 2022 to October 2023, 227 patients (83% white, 15% Black, 1% Asian) were enrolled and 4249 specimens were collected. Adherent cell lines were generated from 15 patients with ovarian cancer and cell suspensions for organoid generation were collected from 46 patients with ovarian cancer. A recharge center was established to self-sustain the Tissue Bank. Samples have been shared with academic and commercial collaborators., Conclusions: Our Tissue Bank has enrolled a large number of diverse patients, collected numerous specimen types, and collaborated widely. The procedures described here provide guidance for other institutions establishing similar resources., Competing Interests: Declaration of competing interest The authors have no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Revision shoulder arthroplasty continues to add an increasing burden on patients and the healthcare system. This study aimed to delineate long-term shoulder arthroplasty revision incidence, quantify associated Medicare spending, and identify relevant predictors of both revision and spending., Methods: The complete 2016-2022 (Q3) Medicare fee-for-service inpatient and outpatient claims data was analyzed. Patients receiving a primary total shoulder arthroplasty (TSA) for osteoarthritis, rotator cuff pathology, or inflammatory arthropathy were included and subsequent ipsilateral revision surgeries were identified. The time to revision was modeled using the Prentice, Williams, and Peterson Gap Time Model. Medicare spending within 90 days postdischarge was modeled using a generalized linear model. The analysis was subdivided by index procedure type: anatomic TSA and reverse shoulder arthroplasty (RSA)., Results: A total of 82,949 primary TSAs and 172,524 RSAs were identified. Compared to index TSA cases, index RSA cases had a lower first revision rate in an observation window of nearly 7 years (1.9% vs. 3.5%, P < .001), but a higher rate of second (11.4% vs. 4.9%, P < .001) as well as third revision (13.8% vs. 13.8%, P = .449). TSA spending was significantly lower than RSA spending for the index procedure ($21,531 vs. $23,267, P < .001), first ($23,096 vs. $26,414, P < .001), and second ($25,060 vs. $29,983, P < .001) revision. There was no statistically significant difference in third revision between TSA and RSA groups ($31,313 vs. $30,829, P = .860). Age, sex, race, and rheumatoid arthritis were among the top predictors of revisions. Top predictors of Medicare spending included having a non-osteoarthritis surgical indication, a hospital stay of 3 or more days, a discharge to a setting other than home, malnutrition, dementia, stroke, major kidney diseases, and being operated on in a teaching hospital., Conclusion: Compared with TSA, RSA was associated with a lower first revision rate, but a higher subsequent revision rate. An index RSA procedure was also associated with higher initial Medicare spending as well as subsequent revision surgery spending compared with an index TSA procedure. Demographics and comorbid medical conditions were among the top predictors of revisions, while procedure-related factors predicted Medicare spending., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Numerous applications and strategies have been utilized to help assess the trends and patterns of readmissions after orthopaedic surgery in an attempt to extrapolate possible risk factors and causative agents. The aim of this work is to systematically summarize the available literature on the extent to which natural language processing, machine learning, and artificial intelligence (AI) can help improve the predictability of hospital readmissions after orthopaedic and spine surgeries., Methods: This is a systematic review and meta-analysis. PubMed, Embase and Google Scholar were searched, up until August 30, 2023, for studies that explore the use of AI, natural language processing, and machine learning tools for the prediction of readmission rates after orthopedic procedures. Data regarding surgery type, patient population, readmission outcomes, advanced models utilized, comparison methods, predictor sets, the inclusion of perioperative predictors, validation method, size of training and testing sample, accuracy, and receiver operating characteristics (C-statistic), among other factors, were extracted and assessed., Results: A total of 26 studies were included in our final dataset. The overall summary C-statistic showed a mean of 0.71 across all models, indicating a reasonable level of predictiveness. A total of 15 articles (57%) were attributed to the spine, making it the most commonly explored orthopaedic field in our study. When comparing accuracy of prediction models between different fields, models predicting readmissions after hip/knee arthroplasty procedures had a higher prediction accuracy (mean C-statistic = 0.79) than spine (mean C-statistic = 0.7) and shoulder (mean C-statistic = 0.67). In addition, models that used single institution data, and those that included intraoperative and/or postoperative outcomes, had a higher mean C-statistic than those utilizing other data sources, and that include only preoperative predictors. According to the Prediction model Risk of Bias Assessment Tool, the majority of the articles in our study had a high risk of bias., Conclusion: AI tools perform reasonably well in predicting readmissions after orthopaedic procedures. Future work should focus on standardizing study methodologies and designs, and improving the data analysis process, in an attempt to produce more reliable and tangible results., Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/B118)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Targeted alpha therapy (TAT) relies on chemical affinity or active targeting using radioimmunoconjugates as strategies to deliver α-emitting radionuclides to cancerous tissue. These strategies can be affected by transmetalation of the parent radionuclide by competing ions in vivo and the bond-breaking recoil energy of decay daughters. The retention of α-emitting radionuclides and the dose delivered to cancer cells are influenced by these processes. Encapsulating α-emitting radionuclides within nanoparticles can help overcome many of these challenges. Poly(lactic-co-glycolic acid) (PLGA) nanoparticles are a biodegradable and biocompatible delivery platform that has been used for drug delivery. In this study, PLGA nanoparticles are utilized for encapsulation and retention of actinium-225 ([ 225 Ac]Ac 3+ ). Encapsulation of [ 225 Ac]Ac 3+ within PLGA nanoparticles (Z ave  = 155.3 nm) was achieved by adapting a double-emulsion solvent evaporation method. The encapsulation efficiency was affected by both the solvent conditions and the chelation of [ 225 Ac]Ac 3+ . Chelation of [ 225 Ac]Ac 3+ to a lipophilic 2,9-bis-lactam-1,10-phenanthroline ligand ([ 225 Ac]AcBLPhen) significantly decreased its release (< 2%) and that of its decay daughters (< 50%) from PLGA nanoparticles. PLGA nanoparticles encapsulating [ 225 Ac]AcBLPhen significantly increased the delivery of [ 225 Ac]Ac 3+ to murine (E0771) and human (MCF-7 and MDA-MB-231) breast cancer cells with a concomitant increase in cell death over free [ 225 Ac]Ac 3+ in solution. These results demonstrate that PLGA nanoparticles have potential as radionuclide delivery platforms for TAT to advance precision radiotherapy for cancer. In addition, this technology offers an alternative use for ligands with poor aqueous solubility, low stability, or low affinity, allowing them to be repurposed for TAT by encapsulation within PLGA nanoparticles., (© 2024. UT-Battelle, LLC.)

Polymer powder bed fusion (PBF) is becoming increasingly popular for the fabrication of lightweight, high-performance parts, particularly for medical and aerospace applications. This study investigates the effect of powder re-use and material aging on the coalescence behaviour, melt flowability, and isothermal crystallisation kinetics of polyamide-12 (PA-12) powder. With increased powder re-use, a progressive reduction in melt flowability and material coalescence is observed; at 200 °C, the particle consolidation time increases from 15 s in virgin powder to 180 s in powder recovered from build 6. The observed changes in the behaviour of PA-12 were attributed to polycondensation and cross-linking; these aging phenomena also create structural defects, which hinder the rate and extent of primary crystallisation. At an isothermal crystallisation temperature of 165 °C, the crystallisation half-time increased from 12.78 min in virgin powder to 23.95 min in powder re-used across six build cycles. As a result, the commonly used Avrami model was found to be unsuitable for modelling the crystallisation behaviour of aged PA-12 powder, with the co-efficient of determination (R 2 ) reducing from >0.995 for virgin powder to as low as 0.795 for re-used powder. On the other hand, an alternative method, the Hay model, is able to successfully track full phase transformation within re-used powder (R 2 > 0.99). These results highlight the importance of selecting the most appropriate model for analysing the crystallisation kinetics of PA-12 powder re-used across multiple build cycles. This understanding is crucial for obtaining the strong mechanical properties and dimensional precision required for the fabrication of functional, end-use parts within PBF.

Mean arterial pressure and cardiac output provide insufficient guidance for the management of intraoperative hypotension (IOH). In silico models offer additional insights into acute changes in hemodynamic parameters that may be encountered during IOH. A computational model (CM) generated parameters quantifying ventricular-vascular coupling, and pressure-volume construct across levels of aortic compliance (C A ). We studied how a loss from normal-to-stiff C A impacts critical care metrics of hemodynamics during vascular occlusion. Pulse pressure (PP), end-systolic pressure (P es ), arterial compliance (Art-ca), arterial elastance (Art-ea), and dynamic arterial elastance (Eadyn), along mechanical efficiency (ME) were measured at five levels of C A . A loss in C A impacted all variables. During steady-state conditions, PP, P es , and stroke work increased significantly as C A decreased. Art-ca decreased and Art-ea increased similarly; Eadyn increased and ME decreased. During a decrease in preload across all C A levels, arterial dynamics measures remained linear. The CM demonstrated that a loss in C A impacts measures of arterial dynamics during steady-state and transient conditions and the model demonstrates that critical care metrics are sensitive to changes in C A . While Art-ca and Art-ea were sensitive to changes in preload, Eadyn did not change., (© 2024 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.)

Introduction/objectives: Insomnia is a common sleep disorders that affects most individuals in the United States, and worldwide. Insomnia is linked with an increased risk of atrial fibrillation (AF) in adults, although the strengths of association were weak, especially in the elderly population. AF is estimated to affect approximately 3 to 6 million people in the United States. We studied the association of AF with insomnia in the elderly population., Methods: We reviewed the electronic medical records of elderly patients who received care in an internal medicine office from July 1, 2020 through June 30, 2021. Patients were grouped into AF group, and a group without AF (NOAF). Association of insomnia and other variables were compared between the 2 groups., Results: Among 2428 patients, 341 (14%) had AF. Patients in the AF group were significantly older compared to no-AF group (80.3 ± 7.9 vs 76.1 ± 7.4 years; P  < .001). A higher frequency of men was noted in AF group versus NOAF group (54.3 vs 42.0%; P  < .001). The frequency of insomnia was significantly higher in AF group versus NOAF group (14.1 vs 9.5%; P  < .05). Additionally, greater frequencies of associations of other comorbid medical conditions were noted in the AF group compared to NOAF group, such as cerebrovascular accident (CVA; 12.9 vs 5.4%; P  < .001), transient ischemic attack (TIA; 7.0 vs 3.0%; P  < .001), dementia (5.9 vs 3.3%; P  < .05), coronary artery disease (CAD; 34.9 vs 18.3%; P  < .001), congestive heart failure (CHF; 21.1 vs 3.8%; P  < .001), other cardiac arrhythmias (53.4 vs 6.3%; P  < .001), chronic obstructive pulmonary disease (COPD; 12.3 vs 5.7%; P  < .001), obstructive sleep apnea (OSA; 17.6 vs 11.8%; P  = .003), chronic kidney disease (CKD; 22.9 vs 11.9%; P  < .001), anemia (23.2 vs 13.0%; P  < .001), and cancer (36.1 vs 27.9%; P  = .002). There was significantly greater odds of AF in patients who had insomnia (OR = 1.972, CI = 1.360-2.851; P  < .001)., Conclusion: AF was associated with insomnia in the elderly population. Higher frequencies of association of AF were also seen with older age, male sex, White race, CVA, TIA, dementia, CAD, CHF, other cardiac arrhythmias, COPD, OSA, CKD, anemia, and cancer., 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.

Introduction/objective: Chronic pain disorders affect about 20% of adults in the United States, and it disproportionately affects individuals living in the neighborhoods of extreme socioeconomic disadvantage. In many instances, chronic pain has been noted to arise from an aggregation of multiple risk factors and events. Therefore, it is of importance to recognize the modifiable risk factors. The aim of this study was to investigate the comorbid medical conditions and risk factors associated with chronic pain disorders in patients aged 65 years and older., Methods: Our team retrospectively reviewed medical records of elderly patients (65 years and older) who were evaluated in our outpatient medicine office between July 1, 2020 and June 30, 2021 for acute problems, management of chronic medical problems, or well visits. We divided our patients into a group who suffered from chronic pain disorder, and another group who did not have chronic pain disorder. The association of variables were compared between those groups., Results: Of the 2431 patients, 493 (20.3%) had a chronic pain disorder. A higher frequency of females in the group with chronic pain disorder was found compared to the group without a chronic pain disorder (60.6% vs 55.2%; P  = .033). The mean ages between the two groups were similar in the group with a chronic pain disorder compared to the group without (76.35 ± 7.5 year vs 76.81 ± 7.59 year; P  = .228). There were significant associations of certain comorbidities in the group with a chronic pain disorder compared to the group without a chronic pain disorder, such as depression (21.9% vs 15.2%; P  < .001), anxiety (27.0% vs 17.1%; P  < .001), chronic obstructive pulmonary disease (8.7% vs 6.1%; P  = .036), obstructive sleep apnea (16.8% vs 11.6%; P  = .002), gastroesophageal reflux disease (40.8% vs 29.0%; P  < .001), osteoarthritis (49.3% vs 26.1%; P  < .001), other rheumatologic diseases (24.9% vs 19.4%; P  = .006), and peripheral neuropathy (14.4% vs 5.3%; P  < .001)., Conclusion: Female sex, depression, anxiety, chronic obstructive pulmonary disease, obstructive sleep apnea, gastroesophageal reflux disease, osteoarthritis, other rheumatologic diseases, and peripheral neuropathy were significantly associated with chronic pain disorder in elderly patients, while BMI was not associated with chronic pain disorder., 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.

Objectives: Surgical planning of vestibular schwannoma surgery would benefit greatly from a robust method of delineating the facial-vestibulocochlear nerve complex with respect to the tumour. This study aimed to optimise a multi-shell readout-segmented diffusion-weighted imaging (rs-DWI) protocol and develop a novel post-processing pipeline to delineate the facial-vestibulocochlear complex within the skull base region, evaluating its accuracy intraoperatively using neuronavigation and tracked electrophysiological recordings., Methods: In a prospective study of five healthy volunteers and five patients who underwent vestibular schwannoma surgery, rs-DWI was performed and colour tissue maps (CTM) and probabilistic tractography of the cranial nerves were generated. In patients, the average symmetric surface distance (ASSD) and 95% Hausdorff distance (HD-95) were calculated with reference to the neuroradiologist-approved facial nerve segmentation. The accuracy of patient results was assessed intraoperatively using neuronavigation and tracked electrophysiological recordings., Results: Using CTM alone, the facial-vestibulocochlear complex of healthy volunteer subjects was visualised on 9/10 sides. CTM were generated in all 5 patients with vestibular schwannoma enabling the facial nerve to be accurately identified preoperatively. The mean ASSD between the annotators' two segmentations was 1.11 mm (SD 0.40) and the mean HD-95 was 4.62 mm (SD 1.78). The median distance from the nerve segmentation to a positive stimulation point was 1.21 mm (IQR 0.81-3.27 mm) and 2.03 mm (IQR 0.99-3.84 mm) for the two annotators, respectively., Conclusions: rs-DWI may be used to acquire dMRI data of the cranial nerves within the posterior fossa., Clinical Relevance Statement: Readout-segmented diffusion-weighted imaging and colour tissue mapping provide 1-2 mm spatially accurate imaging of the facial-vestibulocochlear nerve complex, enabling accurate preoperative localisation of the facial nerve. This study evaluated the technique in 5 healthy volunteers and 5 patients with vestibular schwannoma., Key Points: • Readout-segmented diffusion-weighted imaging (rs-DWI) with colour tissue mapping (CTM) visualised the facial-vestibulocochlear nerve complex on 9/10 sides in 5 healthy volunteer subjects. • Using rs-DWI and CTM, the facial nerve was visualised in all 5 patients with vestibular schwannoma and within 1.21-2.03 mm of the nerve's true intraoperative location. • Reproducible results were obtained on different scanners., (© 2023. The Author(s).)

Protein aggregation is a hallmark of many neurodegenerative disorders, including amyotrophic lateral sclerosis (ALS). Although mutations in TARDBP, encoding transactive response DNA-binding protein 43 kDa (TDP-43), account for less than 1% of all ALS cases, TDP-43-positive aggregates are present in nearly all ALS patients, including patients with sporadic ALS (sALS) or carrying other familial ALS-causing (fALS-causing) mutations. Interestingly, TDP-43 inclusions are also present in subsets of patients with frontotemporal dementia, Alzheimer's disease, and Parkinson's disease; therefore, methods of activating intracellular protein quality control machinery capable of clearing toxic cytoplasmic TDP-43 species may alleviate disease-related phenotypes. Here, we identify a function of nemo-like kinase (Nlk) as a negative regulator of lysosome biogenesis. Genetic or pharmacological reduction of Nlk increased lysosome formation and improved clearance of aggregated TDP-43. Furthermore, Nlk reduction ameliorated pathological, behavioral, and life span deficits in 2 distinct mouse models of TDP-43 proteinopathy. Because many toxic proteins can be cleared through the autophagy/lysosome pathway, targeted reduction of Nlk represents a potential approach to therapy development for multiple neurodegenerative disorders.

Purpose: Large inter-individual variations in post-bariatric fat-free mass loss (FFML) are observed, which might relate to differences in protein intake and physical activity across patients. We performed repetitive assessments of protein intake and physical activity before and after banded Roux-en-Y gastric bypass surgery, and examined its relations to FFML during 6 months of follow-up., Materials and Methods: FFML (bio-impedance analyses), protein intake (24-h dietary recalls) and moderate-to-vigorous physical activity (MVPA; activPAL) were assessed in 28 patients (4 males, age 42 ± 12 years) before surgery and at 1-, 3- and 6-months post-surgery. Changes in protein intake and MVPA were evaluated with mixed model analysis, whereas associations with FFML were assessed by univariate regression analysis., Results: Six-month FFML was -7.3 ± 3.6 kg. Protein intake decreased from 80 ± 29 g/day (pre-surgery) to 45 ± 26 g/day (1 month post-surgery (P < 0.001)) and did not improve thereafter (51 ± 21 g/day; P > 0.05). Seven participants (25%) consumed ≥ 60 g protein/day at 6 months post-surgery. Participants performed 7394 ± 2420 steps/day in 54 ± 20 min/day of MVPA, which did not change from pre- to post-surgery (P > 0.05). A higher step count (B = -0.002; 95%CI = [-0.004 - 0.000]; P = 0.048) and higher level of MVPA (B = -0.29; 95%CI = [-0.54 - -0.03]; P = 0.018) were related to a lower FFML., Conclusion: A lower post-surgery FFML was attributable to higher MVPA levels but not protein intake. This may be due to the low total protein intake and the observation that only a minority of patients achieved a protein intake ≥ 60 g/day. Future studies should focus on interventions to increase post-bariatric protein intake and MVPA levels., (© 2023. The Author(s).)

Background: Some patients with overweight or obesity are not eligible for surgery according to international guidelines or do not wish a surgical intervention. For these patients, different treatment options are being explored. In this study, we examined the effectiveness of the swallowable intragastric balloon (IB) combined with lifestyle coaching, in patients living with overweight and obesity., Method: A retrospective data study was conducted on patients with a swallowable IB placement between December 2018 and July 2021, combined with a 12-month coaching program. Before balloon placement, patients underwent multidisciplinary screening. The IB was swallowed and filled with fluid once in the stomach and naturally excreted around 16 weeks., Results: A total of 336 patients, 71.7% female, were included with a mean age of 45.7 (±11.7) years. Mean baseline weight and BMI were 107.54 (±19.16) kg and 36.1 (±5.02) kg/m 2 . After 1 year, the mean total weight loss was 11.0% (±8.4). The mean placement duration was 13.1 (±2.82) min, and in 43.7%, a stylet was used to facilitate placement. The most common symptoms were nausea (80.4%) and gastric pain (80.3%). In the majority of patients, complaints were resolved within a week. The early deflation of the balloon occurred in 8 patients (2.4%) of which one showed symptoms suggesting a gastric outlet obstruction., Conclusion: Given the low rate of long-term complaints while providing a positive effect on weight loss, we conclude that the swallowable intragastric balloon, combined with lifestyle coaching, is a safe and effective treatment option for patients living with overweight and obesity., (© 2023. The Author(s).)

Climate change is often framed as an environmental concern; however, the burning of fossil fuels both directly and indirectly impacts air quality and, thus, human health. Gas byproducts of combustion lead to increased levels of atmospheric ozone and carbon dioxide, which in turn elevate surface temperatures of the earth. This process exposes individuals to respiratory irritants and contributes to increased frequency of natural disasters such as wildfires, negatively impacting respiratory health. Normal physiologic changes in the respiratory system make pregnant people particularly vulnerable to the effects of air pollution. Asthma and allergic rhinitis are 2 common respiratory diseases that can be triggered by poor air quality. Solutions to limit the impact of climate change on respiratory disease include risk mitigation and reduction of fossil fuel consumption on individual, organization, and community levels. Midwives are well positioned as clinicians to educate people about individual strategies to reduce environmental exposure to respiratory irritants and advocate for policy changes to limit future health effects of climate change., (© 2023 by the American College of Nurse-Midwives.)

Open transosseous rotator cuff repair (RCR) was the original benchmark surgical technique for RCR. The advent of arthroscopic and suture anchor technology shifted the paradigm from open to arthroscopic surgery. Although technological advances have progressed, they come at a cost. Suture anchor technology is expensive, optimal constructs have yet to be determined, and the technology may lead to challenging complications and revision scenarios. In more recent years, a return to transosseous bone tunnels has been described with new arthroscopic techniques, eliminating the need for suture anchors. The purpose of this article is to review the historical, biomechanical, clinical, and economic literature surrounding arthroscopic transosseous RCR., (Copyright © 2023 by the American Academy of Orthopaedic Surgeons.)

Introduction/objectives: Sleep disorders affect around 50 to 70 million Americans, with chronic insomnia being the most common, especially in the elderly population. With an 11-fold increase in the US office visits due to insomnia, from 0.8 to 9.4 million, between 1993 and 2015, it is imperative to identify the modifiable risk factors. The aim of our study was to examine the association of risk factors and comorbid medical conditions with insomnia in patients 65 years, and older., Methods: We performed a retrospective electronic medical record review of the patients aged 65 years and older, who visited our suburban internal medicine office between July 1, 2020 and June 30, 2021. Patients were divided into insomnia group, and the group without insomnia. The associated variables were compared., Results: Among 2431 patients, 247 patients (10.2%) had insomnia. Mean ages of the patients in the insomnia group and the group without insomnia were comparable (77 ± 8.1 year vs 76 ± 7.5 year; P  = .211). There was a significantly greater frequency of women in the insomnia group compared to the group without insomnia (63.2% vs 55.5%; P  = .022). In the insomnia group, there were significantly higher frequencies of association of certain comorbidities compared to the group without insomnia, such as dementia (6.5% vs 3.4%; P  = .015), depression (30.8% vs 14.9%; P  < 0.001), anxiety disorder (34.4% vs 17.4%; P  < .001), atrial fibrillation (19.4% vs 13.4%; P  = .01), and chronic pain disorders (32.8% vs 18.9%; P  < .001). Logistic regression analysis showed significantly greater odds of insomnia in patients who had depression (OR = 1.860, 95% CI 1.342-2.576; P  < .001), anxiety (OR = 1.845, 95% CI 1.342-2.537; P  < .001), and chronic pain disorders (OR = 1.901, 95% CI 1.417-2.549; P  < .001)., Conclusions: Female sex, dementia, depression, anxiety, chronic pain disorders, and atrial fibrillation are associated with insomnia in the elderly patients. Presence of depression, anxiety, and chronic pain disorders are associated with greater odds of having insomnia in the elderly patients.

Objective: To investigate the diagnostic performance of preoperative MRI in evaluating posterolateral corner (PLC) structures after acute knee dislocation (KD) and determine the correlation of MRI with operative findings for grading structure integrity., Methods: Acute knee (femorotibial) dislocations between 2005 and 2020 with preoperative MRI and surgical posterolateral corner repair were identified from a single academic institution. From MRI, integrity was evaluated for PLC structures: lateral collateral ligament (LCL), popliteus tendon (PT), biceps femoris tendon (BFT), and ligamento-capsular complex (LCC). Frequency of injury to each structure and number of PLC structures torn in each case were tabulated. Diagnostic performance of MRI was determined using surgery as the reference standard. Correlation between MRI and surgery for each PLC structure was determined using kappa., Results: Thirty-nine KD cases (19 right) in 39 patients (28 male) were included, with mean age of 33 years. Mechanism of injury was as follows: high energy 52%, low energy 38%, ultra-low energy 10%. LCL was most frequently torn, in 95% (37/39) of cases. Most commonly, three of four PLC structures were torn in 54% (21/39) of cases. Diagnostic accuracy of MRI was high for LCL 95%, BFT 87%, PT 82%, and LCC 92%. Correlation between MRI and surgical findings was variable: substantial for BFT, moderate for LCL and PT, and fair for LCC., Conclusion: MRI has high accuracy for detecting tears of posterolateral corner stabilizers in the setting of acute KD. However, for grading structure integrity, the correlation of MRI with surgical findings is variable, ranging from fair to substantial., Key Points: • In acute knee dislocation, MRI has high diagnostic accuracy for detecting tears of posterolateral corner (PLC) structures. • Preoperative MRI should be considered by orthopedic surgeons when there is clinical concern for posterolateral corner instability following acute knee dislocation. • Although MRI is valuable in the preoperative investigation of knee dislocation, clinical assessment and intraoperative exploration may still be required for definitive diagnosis., (© 2022. The Author(s), under exclusive licence to European Society of Radiology.)

Powder bed fusion (PBF) is an additive manufacturing (AM) technique which offers efficient part-production, light-weighting, and the ability to create complex geometries. However, during a build cycle, multiple aging and degradation processes occur which may affect the reusability of the Polyamide 12 (PA-12) powder. Limited understanding of these phenomena can result in discarding re-usable powder unnecessarily, or the production of parts with insufficient properties, both of which lead to significant amounts of waste. This paper examines the thermal, chemical, and mechanical characteristics of PA-12 via an oven storage experiment that simulates multi jet fusion (MJF) conditions. Changes in the properties of PA-12 powder during oven storage showed two separate, time-dependent trends. Initially, differential scanning calorimetry showed a 4.2 °C increase in melting temperature (T m ) and a rise in crystallinity (X c ). This suggests that secondary crystallisation is occurring instead of, or in addition to, the more commonly reported further polycondensation process. However, with extended storage time, there were substantial reductions in T m and X c , whilst an 11.6 °C decrease in crystallisation temperature was observed. Fourier transform infrared spectroscopy, a technique rarely used in PBF literature, shows an increased presence of imide bonds-a key marker of thermo-oxidative degradation. Discolouration of samples, an 81% reduction in strength and severe material embrittlement provided further evidence that thermo-oxidative degradation becomes the dominant process following extended storage times beyond 100 h. An additional pre-drying experiment showed how moisture present within PA-12 can also accelerate degradation via hydrolysis.

Posterior shoulder instability is increasingly recognized and represents a complex continuum of pathology that can be challenging to diagnose and treat. Current surgical options involve posterior labral repair with or without capsular plication, as well as bony procedures, including glenoid bone grafting and glenoid osteotomy when indicated, often in the setting of revision. There is presently a dearth of surgical options to directly address the root cause of soft tissue failure, including a diminutive posterior labrum, chondrolabral retroversion, and thin or hyperelastic posterior capsule. This article presents a technique for arthroscopically augmenting the posterior capsulolabral complex in the setting of soft tissue insufficiency, laxity, or poor prognostic factors for failure. Secondarily, this technique provides a lower risk revision option for reconstruction in failed posterior instability without glenoid bone defect., (© 2022 The Authors.)

Background: Gastroparesis is a debilitating medical condition with limited treatment options. Gastric per-oral pyloromyotomy (G-POEM) has emerged as a promising treatment option with remarkable short-term clinical success shown in multiple studies. While the post-procedure protocol is not standardized across many centers, the majority of the centers observes these patients in the hospital after the procedure for monitoring. In this single-center prospective study, we evaluated the safety and feasibility of same day discharge after the G-POEM procedure., Methods: All the patients with refractory gastroparesis undergoing G-POEM from October 2019 to March 2020 were enrolled. A total of 25 patients were enrolled in the procedure. Based on the pre-defined criteria, patients were either discharged on the same day after the procedure or admitted to the hospital for further observation. The patient and procedure-related data were extracted from the chart review. Univariate analysis was performed (chi-squared test) on categorical variables after organizing categorical variables as numeric counts or percentages. The student t test was performed on continuous variables after reporting as mean and standard deviation. For analysis with a smaller sample size, Fisher exact and Mann-Whitney tests were used., Results: A total of 25 patients were enrolled. The technical success of G-POEM was 100% and clinical success was 80% (20/25) at 1-month follow-up. Of the 25 patients, 9 patients (36%) were discharged on the same day according to the procedure from the recovery unit. Of the remaining 16 patients who were admitted to the hospital post-procedure, 10 (40%) were admitted due to procedure-related causes while other admissions were either pre-planned or due to social reasons. The average Charlson comorbidity index was lower in the same day discharge group ( P   <  0.05). The number of patients requiring double myotomy was higher in the same day discharge group ( P  < 0.05). The overall complication rate of G-POEM in the study cohort was 12% (3/25) with all complications being mild without any severe adverse events., Conclusion: G-POEM is a safe and effective method of treatment for refractory GP with higher clinical success in short-term follow-up. The same day discharge after G-POEM is safe and feasible in >50% of patients with close periprocedural monitoring., (Copyright © 2022 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.)

There are many techniques described for biceps tenodesis that vary by fixation type, location, and open or arthroscopic method. Clinical outcomes are similar regardless of repair technique; therefore, the cost and time of procedures are increasingly points of improvement to practice value-based medicine and deliver cost-effective care. The technique described in this article builds on previous arthroscopic transosseous technical knowledge to yield a cost-effective and efficient clinical method to perform biceps tenodesis in the suprapectoral location without the cost and complications of an implant. In addition, this technique provides 4 methods of tenodesis in series, which serves to decrease the risk of mechanical failure and leverages the robust method of suture cerclage for capture of the biceps., (© 2022 The Authors.)

Background: Despite the importance of complete, gross total resection (GTR) of fourth ventricular ependymomas, significant morbidity and/or subtotal resections are reported, particularly when the ventricular floor is infiltrated. Step-by-step technique descriptions are lacking in the literature., Objective: To describe monitoring and stimulation mapping techniques and surgical nuances in the challenging subgroup of infiltrating fourth ventricular ependymomas by a highly illustrated, step-by-step description. Superimposed outlines of cranial nerve nuclei on the surgical field demonstrate critical anatomy and facilitate understanding in a way not previously presented., Methods: We reviewed the microanatomical and neurophysiological prerequisites of resecting a diffusively infiltrating fourth ventricular ependymoma., Results: We achieved GTR with the use of reproducible stimulating mapping and accurate cranial nerve nuclei identification., Conclusion: Enhanced microanatomical understanding, reproducible stimulation mapping, and meticulous resection techniques can result in GTR, even in diffusively infiltrating ependymomas., (Copyright © Congress of Neurological Surgeons 2022. All rights reserved.)

Coordinated programs of gene expression drive brain development. It is unclear which transcriptional programs, in which cell-types, are affected in neuropsychiatric disorders such as schizophrenia. Here we integrate human genetics with transcriptomic data from differentiation of human embryonic stem cells into cortical excitatory neurons. We identify transcriptional programs expressed during early neurogenesis in vitro and in human foetal cortex that are down-regulated in DLG2 -/- lines. Down-regulation impacted neuronal differentiation and maturation, impairing migration, morphology and action potential generation. Genetic variation in these programs is associated with neuropsychiatric disorders and cognitive function, with associated variants predominantly concentrated in loss-of-function intolerant genes. Neurogenic programs also overlap schizophrenia GWAS enrichment previously identified in mature excitatory neurons, suggesting that pathways active during prenatal cortical development may also be associated with mature neuronal dysfunction. Our data from human embryonic stem cells, when combined with analysis of available foetal cortical gene expression data, de novo rare variants and GWAS statistics for neuropsychiatric disorders and cognition, reveal a convergence on transcriptional programs regulating excitatory cortical neurogenesis., (© 2022. The Author(s).)