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Atrial fibrillation (AF) is common among patients with hypertrophic cardiomyopathy (HCM) with a prevalence greater than 25%. AF in HCM is associated with a high risk of stroke and can be a marker of more advanced cardiomyopathy. Although, it frequently results in cardiac hemodynamic changes which are poorly tolerated, it can be subclinical. Thus, prompt diagnosis and adequate management of AF are essential to minimizing AF-related adverse outcomes in HCM. All HCM patients should be screened for AF regularly, and those with high-risk features should be screened more frequently preferably with extended ambulatory monitoring. Once AF is detected, oral anticoagulation should be initiated. Both general and HCM-specific modifiable risk factors should be addressed and assessment for cardiomyopathy progression should be performed. Although no randomized controlled studies have compared rate versus rhythm control in HCM, early rhythm control could be considered to prevent further LA remodeling.

(1) Background: Pelvic fractures, and particularly instabilities of the dorsal pelvic ring, are becoming increasingly prevalent, particularly in orthogeriatric patients. Spino-pelvic triangular osteosynthesis is an effective approach to achieve sufficient stabilization in vertically unstable fractures. This study compares two types of osteosynthesis: the conventional one and a novel instrumentation where the iliosacral screw is placed through a fenestrated iliac screw. (2) Methods: Sixteen artificial osteoporotic L5+pelvis models with an unstable sacral fracture have been instrumented with either an iliac screw connected with a rod to a L5 pedicle screw and an iliosacral screw (TF) or a fenestrated ilium screw connected with a rod to a L5 pedicle screw and an iliosacral screw passing through the fenestra of the iliac screw (TFS). Biomechanical testing was performed using cyclic loading until failure. (3) Results: Both configurations yielded comparable results with regard to initial stiffness, implant loosening, and cycles to failure. The TFS exhibited markedly higher values for cycles to failure and markedly lower values for loosening. However, due to the characteristics of the artificial bone model, these findings were not significant. (4) Conclusions: The novel triangular fixation systems demonstrated comparable results to the standard triangular osteosynthesis configuration. [ABSTRACT FROM AUTHOR]

Foreign aid is a controversial tool for helping developing countries achieve economic growth and welfare. Nevertheless, the early 2000s saw a rise in development assistance dedicated to the health sector. The concept of sustainable development highlights the importance of a healthy population to achieve overall development. Using a dataset containing Official Development Assistance channelled towards 100 countries between 2002 and 2020, this paper studies the effect of health aid on health outcomes. To test aid effectiveness, regression models are estimated using infant mortality and life expectancy as proxies for health outcomes. The analyses show that health aid has a positive effect on population health. Moreover, this study tests whether domestic government health expenditure can give further insights into the complex relationship between aid and health improvements. Results yield no significant effect of health aid on public health expenditure; hence no mediation effect can be found. Findings are robust to varying controls and an instrumental variable approach, where two-year lagged health aid is used as instrument. Results also suggest that socioeconomic factors like urbanisation have a positive effect on health outcomes, which implies that population health depends on many factors besides monetary resources. [ABSTRACT FROM AUTHOR]

Background: Although the direct anterior approach (DAA) represents an intermuscular and internervous approach to total hip arthroplasty (THA), it did not reach global acceptance until its adoption by large teaching centers. Today, >50% of primary THA procedures in Switzerland are performed via the DAA. Besides being truly minimally invasive, a key advantage of the DAA is the inherent stability that it provides. A shortcoming has been that the traditional longitudinal skin incision does not follow the skin tension lines1 and therefore can result in wound-healing problems, poor scar cosmesis, and damage to the lateral femoral cutaneous nerve (LFCN). In 2011, we introduced the bikini-type skin-crease incision, and we have utilized it in most of our patients since, with excellent outcomes that are equivalent to those of the traditional incision and superior scar cosmesis2. The bikini incision pertains only to the incisions made at the skin and subcutaneous tissues, which are oblique, whereas the deeper dissection beginning with the fascial sheath of the tensor fasciae latae (TFL) is still performed in the longitudinal direction. In most patients, the incision falls into the flexion crease or slightly distal to it, and today, in order to minimize direct damage to the LFCN3, the incision we perform is always lateral to the anterior superior iliac spine (ASIS)4. From January 2014 until August 2023, a total of 10,009 THA procedures were performed in our unit, with 8,769 being performed via the DAA and 4,969 of those being performed with use of the bikini incision type. The incision type was generally selected according to the experience of the surgeon, with the less-experienced surgeons utilizing classic incision techniques and the high-volume surgeons (i.e., >200 THAs per year) utilizing the bikini incision technique. The bikini incision was utilized in most straightforward cases, but it was not performed if a longitudinal incision had been utilized on the contralateral side or in technically challenging cases. The use of this incision has been adopted by others, with similarly excellent outcomes; however, there is potential for damage to the LFCN5. Several studies utilizing a bikini incision have described the incision as being made quite medial to the ASIS, potentially even crossing the medial branches of the LFCN. In contrast, over years of utilizing the bikini incision technique, our approach has evolved such that the incision is not made medial to the ASIS. Description: The bikini-type (skin-crease) incision only differs from the classic longitudinal approach used for DAA THA with respect to the skin and subcutaneous tissue. To avoid damage to the LFCN, our bikini-type incision has evolved over the last decade to being located entirely lateral to the ASIS (Video 1)3. Alternatives: The main alternative is the classic longitudinal incision used for DAA THA. Rationale: The bikini incision is a valuable alternative that improves wound healing and scar cosmesis in DAA THA in technically straightforward hips, which account for >90% of our cases. The procedure can be divided into 10 steps, as described in the videos. Today, indications include primary or secondary osteoarthritis, femoral neck fracture, and revision THA involving head and/or liner exchange, and simple socket loosening without the need for proximal extension of the approach. Particularly in patients prone to hypertrophic scar formation (i.e., patients who are younger, have a darker skin type, are obese, etc.), this incision is a helpful alternative to the classic longitudinal incision. The classic longitudinal incision is still preferred for complex primary or revision THA cases in which extensile distal and/or acetabular exposure might be required, revision cases with a preexisting longitudinal DAA incision, cases of inguinal skin infection, or cases in which the contralateral side has been treated utilizing a longitudinal incision. Expected Outcomes: A recent review assessed 8 double-armed studies that included a total of 952 bikini incision procedures and 1,361 longitudinal incision procedures. In 3 of the 4 studies reporting postoperative scar appearance and patient satisfaction, those outcomes were more favorable following the bikini incision compared with the longitudinal incision, with the fourth study showing comparable results. Postoperative hip function was similar between the incision types in 3 of 4 studies assessing that outcome5. LFCN injury was the most frequently reported complication, but rates were low overall, and most injuries resolved. Only 2 of the included studies reported slightly higher risks of LFCN injury following use of the bikini incision technique, but their procedures involved large incisions made medial to the ASIS. On the basis of our own prior study as well as other recently reported data2,4, we advocate that the incision be made lateral to the ASIS. Important Tips: Begin with the bikini incision in technically easier hips. Adjust the bikini incision according to radiographic hip morphology. Do not perform the skin incision too small, too distal, too proximal, or most importantly too medial. Secure the medial edge from tearing. Limit subcutaneous dissection. Change the dissection deep to the fascial sheath of the tensor from the oblique to the longitudinal direction. Appreciate that a bikini incision is less extensile. Acronyms and Abbreviations: ASIS = anterior superior iliac spine BMI = body mass index CCD = caput column diaphysis DAA = direct anterior approach GT = greater trochanter LFCA = lateral femoral circumflex artery LFCN = lateral femoral cutaneous nerve TFL = tensor fasciae latae THA = total hip arthroplasty OA = osteoarthritis ROM = range of motion [ABSTRACT FROM AUTHOR]

(1) Background: Demographic changes over the past decade have had a significant impact on pelvic ring fractures. They have increased dramatically in the orthogeriatric population. Surgeons are faced with implant fixation issues in the treatment of these fragility fractures. This study compares two innovative implants for stabilizing the iliosacral joint in a biomechanical setting. (2) Methods: An iliosacral screw with a preassembled plate allowing the placement of an additional short, angular stable screw in the ilium and a triangular fixation system consisting of a fenestrated ilium screw and an iliosacral screw quasi-statically inserted through the "fenestra" were instrumented in osteoporotic artificial bone models with a simulated Denis zone 1 fracture. Biomechanical testing was performed on a servo-hydraulic testing machine using increasing, synchronous axial and torsional sinusoidal cyclic loading to failure. (3) Results: The SI-Plate and TriFix showed comparable stiffness values. The values for fracture gap angle and screw tip cutout were significantly lower for the TriFix compared to the SI-Plate. In addition, the number of cycles to failure was significantly higher for the TriFix. (4) Conclusions: Implant anchorage and primary stability can be improved in iliosacral instability using the triangular stabilization system. [ABSTRACT FROM AUTHOR]