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The glenohumeral joint is the least congruent and least constrained joint with a complex relationship of static and dynamic stabilizers to balance its native mobility with functional stability. In the young athlete, anterior shoulder instability is multifactorial and can be a challenge to treat, requiring a patient-specific treatment approach. Surgical decision-making must consider patient-specific factors such as age, sport activity and level, underlying ligamentous laxity, and goals for return to activity, in addition to careful scrutiny of the underlying pathology to include humeral and glenoid bone loss and surrounding scapular bone morphology. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) and large language models (LLMs) offer a new potential resource for patient education. The answers by Chat Generative Pre-Trained Transformer (ChatGPT), a LLM AI text bot, to frequently asked questions (FAQs) were compared to answers provided by a contemporary Google search to determine the reliability of information provided by these sources for patient education in upper extremity arthroplasty. "Total shoulder arthroplasty" (TSA) and "total elbow arthroplasty" (TEA) were entered into Google Search and ChatGPT 3.0 to determine the ten most FAQs. On Google, the FAQs were obtained through the "people also ask" section, while ChatGPT was asked to provide the ten most FAQs. Each question, answer, and reference(s) cited were recorded. A modified version of the Rothwell system was used to categorize questions into 10 subtopics: special activities, timeline of recovery, restrictions, technical details, cost, indications/management, risks and complications, pain, longevity, and evaluation of surgery. Each reference was categorized into the following groups: commercial, academic, medical practice, single surgeon personal, or social media. Questions for TSA and TEA were combined for analysis and compared between Google and ChatGPT with a 2 sample Z-test for proportions. Overall, most questions were related to procedural indications or management (17.5%). There were no significant differences between Google and ChatGPT between question categories. The majority of references were from academic websites (65%). ChatGPT produced a greater number of academic references compared to Google (80% vs. 50%; P =.047), while Google more commonly provided medical practice references (25% vs. 0%; P =.017). In conjunction with patient-physician discussions, AI LLMs may provide a reliable resource for patients. By providing information based on academic references, these tools have the potential to improve health literacy and improved shared decision making for patients searching for information about TSA and TEA. With the rising prevalence of AI programs, it is essential to understand how these applications affect patient education in medicine. [ABSTRACT FROM AUTHOR]

The purpose of this study is to retrospectively analyze all primary anatomic total shoulder arthroplasty (aTSA) patients within a multicenter international database of a single prosthesis to identify risk factors for patients with rotator cuff tear (RCT) and aseptic glenoid loosening. To investigate the risk factors for RCT and aseptic glenoid loosening, we retrospectively analyzed all aTSA patients with 2-year minimum follow-up from a multicenter international database of a single platform shoulder system, only excluding patients with a history of revision arthroplasty, infections, and humeral fractures. A univariate/multivariate analysis was conducted to compare primary aTSA patients who had report of: 1) a RCT and/or subscapularis failure and 2) aseptic glenoid loosening/cage glenoid dissociations, to identify the differences in (i) intrinsic patient demographics and comorbidities and (ii) implant and operative parameters. Finally, to adapt our statistical analysis for prospective identification of patients most at-risk for RCT and aseptic glenoid loosening, we stratified the dataset by multiple risk factor combinations and calculated the odds ratio (OR) to determine the impact of accumulating risk factors on the incidence rate of each complication. 122 aTSA shoulders had a RCT for a rate of 3.2% and 123 aTSA shoulders had aseptic glenoid loosening for a rate of 3.3%. The multivariate analysis identified that aTSA patients with RCT were more likely to have previous shoulder surgery (P <.001) and small size glenoids (P =.002). Additionally, the multivariate analysis identified that aTSA patients with aseptic glenoid loosening were more likely to be younger (≤62 years at the time of surgery, P =.001), have small size glenoids (P =.033) and have a nonhybrid glenoids (P <.001). Stratifying patients with multiple risk factors identified multiple aTSA cohorts with ORs >2 for RCT or aseptic glenoid loosening. This analysis of 2699 primary aTSA identified risk factors for the two most common postoperative complications: RCTs and aseptic glenoid loosening. Using these risk factors, we calculated ORs for patient cohorts with multiple risk factors to identify the patients with the greatest risk for each complication. This information is useful to guide the surgeon in their preoperative counseling and potentially mitigate the occurrence of these complications, by indicating patients with these risk-factors for alternative treatment strategies, like rTSA, instead of aTSA. [ABSTRACT FROM AUTHOR]

Reverse total shoulder arthroplasty (RTSA) is increasingly used as a treatment modality for various pathologies. The purpose of this review is to identify preoperative risk factors associated with loss of internal rotation (IR) after RTSA. A systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Ovid MEDLINE, Ovid Embase, and Scopus were queried. The inclusion criteria were as follows: articles in English language, minimum 1-year follow-up postoperatively, study published after 2012, a minimum of 10 patients in a series, RTSA surgery for any indication, and explicitly reported IR. The exclusion criteria were as follows: articles whose full text was unavailable or that were unable to be translated to English language, a follow-up of less than 1 year, case reports or series of less than 10 cases, review articles, studies in which tendon transfers were performed at the time of surgery, procedures that were not RTSA, and studies in which the range of motion in IR was not reported. The search yielded 3792 titles, and 1497 duplicate records were removed before screening. Ultimately, 16 studies met the inclusion criteria with a total of 5124 patients who underwent RTSA. Three studies found that poor preoperative functional IR served as a significant risk factor for poor postoperative IR. Eight studies addressed the impact of subscapularis, with 4 reporting no difference in IR based on subscapularis repair and 4 reporting significant improvements with subscapularis repair. Among studies with sufficient power, BMI was found to be inversely correlated with degree of IR after RTSA. Preoperative opioid use was found to negatively affect IR. Other studies showed that glenoid retroversion, component lateralization, and individualized component positioning affected postoperative IR. This study found that preoperative IR, individualized implant version, preoperative opioid use, increased body mass index and increased glenoid lateralization were all found to have a significant impact on IR after RTSA. Studies that analyzed the impact of subscapularis repair reported conflicting results. [ABSTRACT FROM AUTHOR]

The burden of cardiac death after transcatheter aortic valve replacement (TAVR), particularly from advanced heart failure (HF) and sudden cardiac death (SCD), remains largely unknown. This study sought to evaluate the incidence and predictors of SCD and HF-related death in TAVR recipients treated with newer-generation devices. This study included a total of 5,421 consecutive patients who underwent TAVR with newer-generation devices using balloon (75.7%) or self-expandable (24.3%) valves. After a median follow-up of 2 (IQR: 1-3) years, 976 (18.0%) patients had died, 50.8% from cardiovascular causes. Advanced HF and SCD accounted for 11.6% and 7.5% of deaths, respectively. Independent predictors of HF-related death were atrial fibrillation (HR: 2.17; 95% CI: 1.47-3.22; P < 0.001), prior pacemaker (HR: 1.79; 95% CI: 1.10-2.92; P = 0.01), reduced left ventricular ejection fraction (HR: 1.08 per 5% decrease; 95% CI: 1.01-1.14; P = 0.02), transthoracic approach (HR: 2.50; 95% CI: 1.37-4.55; P = 0.003), and new-onset persistent left bundle branch block (HR: 1.85; 95% CI: 1.14-3.02; P = 0.01). Two baseline characteristics (diabetes, HR: 1.81; 95% CI: 1.13-2.89; P = 0.01; and chronic kidney disease, HR: 1.72; 95% CI: 1.02-2.90; P = 0.04) and 3 procedural findings (valve in valve, HR: 2.17; 95% CI: 1.01-4.64; P = 0.04; transarterial nontransfemoral approach, HR: 2.23; 95% CI: 1.23-4.48; P = 0.01; and periprocedural ventricular arrhythmia, HR: 7.19; 95% CI: 2.61-19.76; P < 0.001) were associated with an increased risk of SCD after TAVR. Advanced HF and SCD accounted for a fifth of deaths after TAVR in contemporary practice. Potentially treatable factors leading to increased risk of HF deaths and SCD were identified, such as arrhythmia/dyssynchrony factors for HF and valve-in-valve TAVR or periprocedural ventricular arrhythmias for SCD. [Display omitted] [ABSTRACT FROM AUTHOR]

In patients undergoing percutaneous coronary intervention (PCI) in the work-up pre–transcatheter aortic valve replacement (TAVR), the incidence and clinical impact of late bleeding events (LBEs) remain largely unknown. This study sought to determine the incidence, clinical characteristics, associated factors, and outcomes of LBEs in patients undergoing PCI in the work-up pre-TAVR. This was a multicenter study including 1,457 consecutive patients (mean age 81 ± 7 years; 41.5% women) who underwent TAVR and survived beyond 30 days. LBEs (>30 days post-TAVR) were defined according to the Valve Academic Research Consortium-2 criteria. LBEs occurred in 116 (7.9%) patients after a median follow-up of 23 (IQR: 12-40) months. Late bleeding was minor, major, and life-threatening or disabling in 21 (18.1%), 63 (54.3%), and 32 (27.6%) patients, respectively. Periprocedural (<30 days post-TAVR) major bleeding and the combination of antiplatelet and anticoagulation therapy at discharge were independent factors associated with LBEs (P ≤ 0.02 for all). LBEs conveyed an increased mortality risk at 4-year follow-up compared with no bleeding (43.9% vs 36.0; P = 0.034). Also, LBE was identified as an independent predictor of all-cause mortality after TAVR (HR: 1.39; 95% CI: 1.05-1.83; P = 0.020). In TAVR candidates with concomitant significant coronary artery disease requiring percutaneous treatment, LBEs after TAVR were frequent and associated with increased mortality. Combining antiplatelet and anticoagulation regimens and the occurrence of periprocedural bleeding determined an increased risk of LBEs. Preventive strategies should be pursued for preventing late bleeding after TAVR, and further studies are needed to provide more solid evidence on the most safe and effective antithrombotic regimen post-TAVR in this challenging group of patients. [Display omitted] [ABSTRACT FROM AUTHOR]

Arthroscopic shoulder surgery can be performed for retrieval of bullets and retained metallic fragments in the glenohumeral and subacromial spaces. Previous case reports and case series have demonstrated the effectiveness of an arthroscopic approach over an open procedure, as it is less invasive, allows for improved inspection and documentation of the joint surfaces and periarticular structures, and potentially leads to a faster recovery. An arthroscopic approach for extracting foreign bodies from both the quadrilateral space and the posterior extra-articular space by first accessing the glenohumeral space has yet to be described. This inside-out technique may afford surgeons the potential for improved visualization and less morbidity compared with a traditional open posterior approach. We report a technique for an arthroscopic inside-out approach for removal of extra-articular foreign bodies retained in either the quadrilateral space or the posterior extra-articular space. [Display omitted] [ABSTRACT FROM AUTHOR]

The purpose of this study is to determine the improvement of pain and postoperative function after reverse total shoulder arthroplasty (rTSA) in patients who have severe preoperative pain. We hypothesized that these patients would have lower postoperative function and not experience the same scaled improvement as other patients. After the application of exclusion criteria, 214 patients who underwent primary rTSA in a 6-year period and had at least one year outcome data met the inclusion criteria. Age, demographics, preoperative, and 1-year postoperative pain visual analog scale (VAS) were recorded, range of motion (ROM), subjective shoulder value (SSV), and postoperative shoulder outcome scores (American Shoulder and Elbow Surgeons, Simple Shoulder Test, University of California-Los Angeles, and Constant) were collected. Additional information, such as number of patient-reported allergies, history of anxiety/depression, preoperative use of antidepressants/anxiolytics/psychotropics, and preoperative opioid usage, were also obtained. Patients were separated into two cohorts as follows: severe preoperative pain (VAS scores of 9-10, n = 114) and lower preoperative pain (VAS scores < 9, n = 110). Patients with severe preoperative pain had significantly lower preoperative SSV and ROM in each category compared to the other cohort. Postoperative differences in VAS, ROM, and outcome scores were not significant between the severe preoperative pain cohort and the lower preoperative pain cohort. When examining the changes in outcomes from preoperatively to postoperatively, patients with severe preoperative pain experienced statically significant improvements in VAS, SSV, and all ROM measurements except for active external rotation. No significant differences were seen in the number of patient-reported allergies, tobacco usage, history of anxiety/depression, usage of antidepressants/anxiolytics/psychotropics, or preoperative opioid usage between the two groups. This study demonstrated that patients with severe preoperative pain had significantly lower shoulder function preoperatively. However, these patients had similar outcomes after rTSA compared to other patients undergoing the same procedure who did not report severe preoperative pain. Further, these patients experience a significant increase in shoulder function and decrease in pain after rTSA compared to preoperative assessments, in contrast to other patients who did not report severe preoperative pain. [ABSTRACT FROM AUTHOR]

• Lagascea decipiens flowers show distinctive lipid and total protein contents. • Polyunsaturated and monounsaturated fatty acids predominate in leaves and flowers. • The leaves and flowers are sources of essential amino acids. • Alpha-linolenic acid and lysine stand out as components in leaves and flowers. • The flowers contain α-tocopherol and show antioxidant potential against DPPH radical. The Asteraceae family includes species used for food or medicinal remedies, one of which is Lagascea decipiens , which is native to the Sierra Madre Occident in Mexico. Because this plant has not been previously characterized, its biochemical components and antioxidant and antimicrobial activities were quantified in its flowers, leaves and stems. The leaves are sources of ash (20.37 g/100 g dry weight) and the flowers of total lipids (7.32 g/100 g dry weight). According to their fatty acid profile, the leaves provide polyunsaturated fatty acids (63.25 %), the most abundant of which is alpha-linolenic acid. Leaves are the main source of essential amino acids (55.58 ± 0.05 mg/g dry weight) and α-tocopherol (201.96 ± 19.68 µg/g dry weight). The antioxidant activity against the radical DPPH was higher in the flowers (20.04 ± 0.04 µmol eq. of Trolox/g of extract dry weight) than in other parts. The aqueous or alcoholic extracts of the plant did not show activity against selected microorganisms. Due to their biochemical components and antioxidant activity, the leaves and flowers of the native plant L. decipiens have potential for use in the food and medicinal industries. [ABSTRACT FROM AUTHOR]

• Patients with pure AR on non-calcified valves are contraindicated for surgery. • TAVI could be an interesting alternative to surgery in this setting. • Few data exist on the use of the balloon-expandable SAPIEN 3 THV. • TAVI for pure AR using the SAPIEN 3 THV seems technically feasible. • However, the procedure may be challenging and requires specific precautions. Transcatheter aortic valve implantation now has a major role in the treatment of patients with severe aortic stenosis. However, evidence is scarce on its feasibility and safety to treat patients with pure aortic regurgitation. We sought to evaluate the results of transcatheter aortic valve implantation using the balloon-expandable SAPIEN 3 transcatheter heart valve (Edwards Lifesciences, Irvine, CA, USA) in patients with pure aortic regurgitation on native non-calcified valves. We conducted a retrospective and prospective French multicentre observational study. We included all patients with symptomatic severe pure aortic regurgitation on native non-calcified valves, contraindicated to or at high risk for surgical valve replacement, who underwent transcatheter aortic valve implantation using the SAPIEN 3 transcatheter heart valve. A total of 37 patients (male sex, 73%) with a median age of 81 years (interquartile range 69–85 years) were screened using transthoracic echocardiography and computed tomography and were included at eight French centres. At baseline, 83.8% of patients (n = 31) had dyspnoea New York Heart Association class ≥ III. The device success rate was 94.6% (n = 35). At 30 days, the all-cause mortality rate was 8.1% (n = 3) and valve migration occurred in 10.8% of cases (n = 4). Dyspnoea New York Heart Association class ≤ II was seen in 86.5% of patients (n = 32), and all survivors had aortic regurgitation grade ≤ 1. At 1-year follow-up, all-cause mortality was 16.2% (n = 6), 89.7% (n = 26/29) of survivors were in New York Heart Association class ≤ II and all had aortic regurgitation grade ≤ 2. Transcatheter aortic valve implantation using the SAPIEN 3 transcatheter heart valve seems promising to treat selected high-risk patients with pure aortic regurgitation on non-calcified native valves, contraindicated to surgical aortic valve replacement. [ABSTRACT FROM AUTHOR]

Currently, there is a high demand for fresh, minimally processed foods. Therefore, the search for natural compounds that can be used to increase the quality and shelf life of food, as well as to control or eliminate the development of pathogens has been increasing. The general objective was to determine the simultaneous production, at a controlled pH 6, of bacteriocin and bioemulsifier by the Enterococcus mundtii Tw278 strain and evaluate the conservation capacity in a food model. The pH control did not affect the production of the compounds when the optimal production media were used (LAPTg for bacteriocin and LAP LW for bioemulsifier), respectively. The values obtained for bacteriocin were 819,200 AU/mL at 9 h in the batch, while this value was obtained at 12 h in the reactor. The highest emulsification index (E24) was 60.97 at 24 h in the batch, while in the reactor, it was 54.3 at 12 h. The bioemulsifier produced would be a glyprotein, according to FTIR analysis, with the capacity to form polydisperse oil-in-water emulsions with particles with an average diameter of 50 μm. Finally, it was found that E. mundtii Tw278 strain, as well as its antilisteria extract, were able to control and reduce the initial population of 3.4 log CFU/mL of Listeria monocytogenes Scott A to undetectable values in a yogurt model, with production at 42 °C for 8 h and storage at 4 °C for 15 days and bacteriocinogenic strain and its extract did not alter the physicochemical properties inherent to yogurt. [ABSTRACT FROM AUTHOR]

The integration of artificial intelligence (AI) with human intelligence (HI) has been asserted to provide transformational power across the humanitarian supply chain (HSC). However, there is little rigorous work that analyses the enablers that promote AI–HI integration and application in the HSC. Thus, this paper reports a hybrid decision support framework for analysing enablers of AI–HI integration in the HSC with complicated, uncertain, and periodic information. First, to collect interdependent preference data from experts, the complex spherical fuzzy weighted Heronian mean operator with a weighted distance measures-based optimization model is established to generate a group decision matrix. Next, to measure the influence strength of enablers, a complex spherical fuzzy decision-making trial and evaluation method is established to determine enabler weights, taking into account their interactive relationships. After that, to explore the enabler level of AI–HI integration in different participants of the HSC, the complex spherical fuzzy measurement of alternatives and ranking according to the compromise solution method is developed by combining the former two procedures. Finally, a case study of enablers analysis for AI–HI integration in HSC is presented to assess the feasibility of the current method, which includes sensitivity and comparison studies. The results reveal that the factor "enhancing the efficiency of relief operations" (0.084) is the most important driving factor for AI–HI integration. The outcomes of this study can provide a new decision support method for understanding the enablers of AI–HI integration in key parts of the HSC. • An integrated CSF-decision framework is proposed to assess enablers of AI-HI integration. • The inter-dependencies between estimation information distributions are considered. • The expansion of the CSF-DEMATEL is proposed to assign enablers weights. • An improved CSF-MARCOS model is developed to estimate enablers of AI-HI integration in HSC. [ABSTRACT FROM AUTHOR]

Primary reverse shoulder arthroplasty (rTSA) is an effective treatment option for reducing pain and improving function for patients with rotator cuff tear arthropathy, irreparable rotator cuff tears, glenoid deformity, and other challenging clinical scenarios, including fracture sequelae and revision shoulder arthroplasty. There has been a wide range of reported outcomes and postoperative complication rates reported in the literature. The purpose of this systematic review and meta-analysis is to provide an updated review of the clinical outcomes and complication rates following primary rTSA. A systematic review and meta-analysis was performed to evaluate outcomes and complications following primary rTSA according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Demographics, range of motion, patient-reported outcome measures (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES] and Constant scores), number of complications, and revisions were extracted, recorded, and analyzed from the included articles. Of the 1415 studies screened, 52 studies met the inclusion criteria comprising a total of 5824 shoulders. The mean age at the time of surgery was 72 years (range: 34-93), and the mean follow-up was 3.9 years (range: 2-16). Patients demonstrated a mean improvement of 56° in active flexion, 50° in active abduction, and 14° in active external rotation. Regarding functional outcome scores, rTSA patients demonstrated a mean clinically significant improvement of 37 in Constant score (minimal clinically important difference [MCID] = 5.7) and ASES score (42.0; MCID = 13.6). The overall complication rate for rTSA was 9.4% and revision rate of 2.6%. Complications were further subdivided into major medical complications (0.07%), shoulder- or surgical-related complications (5.3%), and infections (1.2%). The most frequently reported shoulder- or surgical-related complications were scapular notching (14.4%), periprosthetic fracture (0.8%), glenoid loosening (0.7%), and prosthetic dislocation (0.7%). Primary rTSA is a safe and reliable procedure with low complication, revision, infection, and scapular notching rates. Additionally, patients demonstrated clinically significant improvements in both range of motion and clinical outcome scores. [ABSTRACT FROM AUTHOR]

Although reverse total shoulder arthroplasty (RSA) is considered a safe surgical option in elderly patients, large-scale analyses of complications and mortality after RSA in patients 80 years and older are scarce. The goals of the current study were to identify revision, complication, and early mortality rates after RSA in patients 80 years and older and compare these to younger patients. The PearlDiver Database, which contains services rendered to Medicare, Medicaid, and commercial insurance patients, was queried for patients undergoing RSA using International Classification of Diseases, Ninth/Tenth Revision (ICD-9 / ICD-10) procedure codes. Patients were separated into 2 groups based on their age: 80 years and older and <80 years of age. The incidence of revision arthroplasty, medical, and surgical complications after RSA were extracted. Multivariate regression was used to compare revision arthroplasty and complication rates between groups. Statistical significance was set at P <.05. A total of 29,430 cases of RSA were included, with 486 cases in patients 80 years and older (median age, 80 years; age range, 2 years). Patients 80 years and older had 1- and 2-year revision rates of 3.9% and 5.1%, compared with the younger cohort at 3.0% and 3.1%, respectively. In patients 80 years and older, there were higher rates of deep venous thrombosis (DVT) (odds ratio [OR] 2.87, 95% CI 1.5-4.97), urinary tract infection (OR 1.42, 95% CI 1.01-1.94), acute renal failure (OR 2.18, 95% CI 1.44-3.17), and pneumonia (OR 1.75, 95% CI 1.09-2.68) within 90 days postoperatively. Ninety-day surgical complications were similar between the cohorts; however, younger patients experienced higher rates of dislocation, stiffness, periprosthetic fracture, and implant complications 1 year postoperatively. Patients 80 years and older had a significantly higher 90-day mortality rate at 2.7% compared with 1.5% in younger patients (P =.002). RSA is a generally safe procedure even in patients 80 years and older, with low complication and revision rates. Patients 80 years and older had higher early mortality and medical complication rates, including DVT, renal failure, and pneumonia than patients <80 years of age. However, patients 80 years and older had lower rates of dislocation, periprosthetic fracture, and implant-related complication at 1 year postoperatively. [ABSTRACT FROM AUTHOR]

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Seaweeds represent a potential source of new food products with enhanced sustainability. However, in order to use seaweeds as ingredients more knowledge is needed regarding the impact of processing on their structuring ability and functionality. We report on the structure and rheology of aqueous dispersions of two species of brown seaweed, namely: Laminaria digitata and Saccharina latissima , prepared by different food processing techniques. High pressure homogenisation disrupted seaweed cell walls, leading to stable weak gels characterised by smaller particle size compared to untreated samples. Thermal treatment (70 °C 1 h), applied prior or during shear treatment, did not impact the particle size, however, it led to serum phases with higher viscosities. This was related to an increased solubilisation of polysaccharides from the cell walls into the serum, as reflected by chemical analysis and small angle X-ray scattering (SAXS). Furthermore, although in terms of rheological behaviour and particle size, both species showed similar response to food processing conditions, the cell wall nanostructure of L. digitata was modified to a larger extent compared to S. latissima , which was linked to a higher solubilisation of polysaccharides. These insights regarding functionalisation of brown seaweed dispersions provide the scientific knowledge to use whole seaweed as natural structurants for future food and other technological applications. [Display omitted] • Stable aqueous dispersions of brown seaweeds were prepared by food processing. • Mechanical cell disruption, with or without heating, induced polysaccharide release. • L. digitata cell walls were more labile than those of S. latissima. • The treated dispersions from both species showed gel-like behaviour. • Structuring ability was dominated by seaweed particles rather than serum viscosity. [ABSTRACT FROM AUTHOR]

Biceps tenodesis and tenotomy are both effective surgical procedures for management of shoulder pain and dysfunction secondary to SLAP tears, biceps tendinitis, rotator interval pulley lesions, and failed SLAP repairs. These procedures are generally safe with low complication rates. However, failure of a proximal biceps tenodesis or tenotomy can rarely lead to symptomatic Popeye deformity with pain and cramping with repetitive forearm supination and elbow flexion. Surgical revision is indicated in young active patients to restore the length tension relationship of the biceps brachii to improve supination and flexion strength, as well as to provide symptomatic relief and improved endurance. Failed biceps tenodesis can be a challenging surgical scenario, as oftentimes there is limited available proximal biceps tendon tissue, especially in the setting of prior subpectoral biceps tenodesis. We report a technique of revision open subpectoral biceps tenodesis with allograft tendon augmentation for the management of symptomatic Popeye deformity in young active patients with little to no remaining proximal biceps tendon. [Display omitted] [ABSTRACT FROM AUTHOR]

Minimally invasive techniques show improved short-term and comparable long-term outcomes compared to open techniques in the treatment of gastric cancer and improved survival has been seen with the implementation of multimodality treatment. Therefore, focus of research has shifted towards optimizing treatment regimens and improving quality of life. A randomized trial was performed in thirteen hospitals in Europe. Patients were randomized between open total gastrectomy (OTG) or minimally invasive total gastrectomy (MITG) after neoadjuvant chemotherapy. This study investigated patient reported outcome measures (PROMs) on health-related quality of life (HRQoL) following OTG or MITG, using the Euro-Qol-5D (EQ-5D) and the European Organization for Research and Treatment of Cancer (EORTC) questionnaires, modules C30 and STO22. Due to multiple testing a p-value < 0.001 was deemed statistically significant. Between January 2015 and June 2018, 96 patients were included in this trial. Forty-nine patients were randomized to OTG and 47 to MITG. A response compliance of 80% was achieved for all PROMs. The EQ5D overall health score one year after surgery was 85 (60–90) in the open group and 68 (50–83.8) in the minimally invasive group (P = 0.049). The median EORTC-QLQ-C30 overall health score one year postoperatively was 83,3 (66,7–83,3) in the open group and 58,3 (35,4–66,7) in the minimally invasive group (P = 0.002). This was not statistically significant. No differences were observed between open total gastrectomy and minimally invasive total gastrectomy regarding HRQoL data, collected using the EQ-5D, EORTC QLQ-C30 and EORTC-QLQ-STO22 questionnaires. [ABSTRACT FROM AUTHOR]

Background: Experimental evidence suggests that sedentary time (ST) may contribute to cardiovascular disease by eliciting detrimental hemodynamic changes in the lower limbs. However, little is known about objectively measured ST and lower extremity peripheral artery disease (PAD).Methods: We included 7,609 Hispanic/Latinos (ages 45-74) from the Hispanic Community Health Study/Study of Latinos. PAD was measured using the ankle brachial index (≤0.9). ST was measured using accelerometry. We used multivariable logistic regression to assess associations of quartiles of ST and PAD, and then used the same logistic models with restricted cubic splines to investigate continuous nonlinear associations of ST and PAD. Models were sequentially adjusted for traditional PAD risk factors, leg pain, and moderate- to vigorous-intensity physical activity (MVPA).Results: Median ST was 12.2 h/d, and 5.4% of individuals had PAD. In fully adjusted restricted cubic splines models accounting for traditional PAD risk factors, leg pain, and MVPA, ST had a significant overall (P = .048) and nonlinear (P = .024) association with PAD. A threshold effect was seen such that time spent above median ST was associated with higher odds of PAD. That is, compared to median ST, 1, 2, and 3 hours above median ST were associated with a PAD odds ratio of 1.16 (95% CI = 1.02-1.31), 1.44 (1.06-1.94), and 1.80 (1.11-2.90), respectively.Conclusions: Among Hispanic/Latino adults, ST was associated with higher odds of PAD, independent of leg pain, MVPA, and traditional PAD risk factors. Notably, we observed a threshold effect such that these associations were only observed at the highest levels of ST. [ABSTRACT FROM AUTHOR]

Paravalvular leak (PVL), conduction disturbances and vascular complications remain the most common post-TAVR complications. To address these adverse outcomes, the 3rd generation of transcatheter heart valves has been developed. Last generation prosthesis provides an outer pericardial wrap for enhanced sealing and PVL prevention. The aim of this study was to compare incidence and severity of PVL, and 1-year survival after TAVR with SAPIEN 3 versus EVOLUT PRO. An observational retrospective analysis was conducted on 1481 patients who underwent TAVR for symptomatic severe aortic stenosis in six different European centres. The primary endpoint was to assess the frequency and severity of PVL at 30-days post-TAVR. The secondary endpoint was to compare 1-year survival between EVOLUT PRO and SAPIEN 3. SAPIEN 3 transcatheter heart valve was implanted in 78.3% (n = 1160) of study participants while EVOLUT PRO in 21.7% (n = 321). PVL is more commonly observed in the EVOLUT PRO at pre-hospital discharge (55.1% vs. 37.3%), 1-month (51% vs. 41.4%) and 1-year (51.3% vs. 39.3%) follow-up. This difference mainly concerns low grade (mild/trace) PVL. The frequency of high degree (moderate/severe) PVL was almost similar in both groups throughout the study period (5.3% vs. 5.8% pre-hospital discharge, 4% vs. 3.1% at 1-month and 3.2% vs. 4.9% at 1-year). No significant difference in survival over 1-year has been observed [HR = 0.73 (0.33–1.63), P = 0.442]. The detection rate of PVL post-TAVR with 3rd heart valves generation remains high. There are no major differences between both devices regarding the frequency of significant (moderate/severe) PVL and survival. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare, in a cohort of patients with complex coronary artery disease (CAD) and severe aortic stenosis (AS), the clinical outcomes associated with transfemoral transcatheter aortic valve replacement (TAVR) (plus percutaneous coronary intervention [PCI]) versus surgical aortic valve replacement (SAVR) (plus coronary artery bypass grafting [CABG]). Patients with complex CAD were excluded from the main randomized trials comparing TAVR with SAVR, and no data exist comparing TAVR + PCI vs SAVR + CABG in such patients. A multicenter study was conducted including consecutive patients with severe AS and complex CAD (SYNTAX [Synergy Between PCI with Taxus and Cardiac Surgery] score >22 or unprotected left main disease). A 1:1 propensity-matched analysis was performed to account for unbalanced covariates. The rates of major adverse cardiac and cerebrovascular events (MACCE), including all-cause mortality, nonprocedural myocardial infarction, need for new coronary revascularization, and stroke, were evaluated. A total of 800 patients (598 undergoing SAVR + CABG and 202 undergoing transfemoral TAVR + PCI) were included, and after propensity matching, a total of 156 pairs of patients were generated. After a median follow-up period of 3 years (interquartile range: 1-6 years), there were no significant differences between groups for MACCE (HR for transfemoral TAVR vs SAVR: 1.33; 95% CI: 0.89-1.98), all-cause mortality (HR: 1.25; 95% CI: 0.81-1.94), myocardial infarction (HR: 1.16; 95% CI: 0.41-3.27), and stroke (HR: 0.42; 95% CI: 0.13-1.32), but there was a higher rate of new coronary revascularization in the TAVR + PCI group (HR: 5.38; 95% CI: 1.73-16.7). In patients with severe AS and complex CAD, TAVR + PCI and SAVR + CABG were associated with similar rates of MACCE after a median follow-up period of 3 years, but TAVR + PCI recipients exhibited a higher risk for repeat coronary revascularization. Future trials are warranted. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: The arrhythmic burden after discharge in patients with new-onset left bundle branch block (LBBB) undergoing transcatheter aortic valve replacement (TAVR) with the balloon-expandable SAPIEN 3 (S3) valve remains largely unknown.Objective: The purpose of this study was to determine the incidence of late arrhythmias in patients with new-onset LBBB undergoing TAVR with the balloon-expandable S3 valve.Methods: This was a multicenter, prospective study that included 104 consecutive TAVR patients with new-onset persistent LBBB following TAVR with the S3 valve. An implantable cardiac monitor (Reveal XT, Reveal LINQ) was implanted before discharge. The primary endpoint was the incidence of high-degree atrioventricular block or complete heart block (HAVB/CHB).Results: A total of 40 patients (38.5%) had at least 1 significant arrhythmic event, leading to a treatment change in 17 (42.5%). Significant bradyarrhythmias occurred in 20 of 104 patients (19.2%) (34 HAVB/CHB episodes, 252 severe bradycardia episodes), with 10 of 20 patients (50%) exhibiting at least 1 episode of HAVB/CHB. Most HAVB/CHB episodes (60%) occurred within 4 weeks after discharge. Nine patients (8.7%) underwent permanent pacemaker implantation at 12 months based on the Reveal findings (6 HAVB/CHB, 3 severe bradycardia).Conclusion: S3 valve recipients with new-onset LBBB have a high arrhythmic burden, with more than one-third of patients exhibiting at least 1 significant arrhythmic episode within 12 months (HAVB/CHB in 10% of patients). About one-half of bradyarrhythmic events occurred within 4 weeks after discharge. These results should inform future strategies on the use of continuous electrocardiographic monitoring in TAVR S3 patients with new conduction disturbances following the procedure. [ABSTRACT FROM AUTHOR]

[Display omitted] Even though exosome-based therapy has been shown to be able to control the progression of different pathologies, the data revealed by pharmacokinetic studies warn of the low residence time of exogenous exosomes in circulation that can hinder the clinical translation of therapeutic exosomes. The macrophages related to the organs of the mononuclear phagocytic system are responsible primarily for the rapid clearance and retention of exosomes, which strongly limits the amount of exosomal particles available to reach the target tissue, accumulate in it and release with high efficiency its therapeutic cargo in acceptor target cells to exert the desired biological effect. Endowing exosomes with surface modifications to evade the immune system is a plausible strategy to contribute to the suppression of exosomal clearance and increase the efficiency of their targeted content delivery. Here, we summarize the current evidence about the mechanisms underlying the recognition and sequestration of therapeutic exosomes by phagocytic cells. Also, we propose different strategies to generate 'invisible' exosomes for the immune system, through the incorporation of different anti-phagocytic molecules on the exosomes' surface that allow increasing the circulating half-life of therapeutic exosomes with the purpose to increase their bioavailability to reach the target tissue, transfer their therapeutic molecular cargo and improve their efficacy profile. Macrophage-mediated phagocytosis are the main responsible behind the short half-life in circulation of systemically injected exosomes, hindering their therapeutic effect. Exosomes 'Camouflage Cloak' strategy using antiphagocytic molecules can contribute to the inhibition of exosomal clearance, hence, increasing the on-target effect. Some candidate molecules that could exert an antiphagocytic role are CD47, CD24, CD44, CD31, β2M, PD-L1, App1, and DHMEQ. Pre- and post-isolation methods for exosome engineering are compatible with the loading of therapeutic cargo and the expression of antiphagocytic surface molecules. [ABSTRACT FROM AUTHOR]

We study a successful model to explain the muon anomalous magnetic moment originating from Yukawa-type interactions in a supersymmetric theory. Thanks to a modular A 4 flavor symmetry, any lepton flavor violations that spoil the model are forbidden. We also investigate a predictive radiative seesaw model including a dark matter (DM) candidate. At first, we construct the minimum model to satisfy the neutrino oscillation data and obtain several predictions such as Dirac CP and Majorana phases, the neutrino masses through χ 2 analysis. However, the minimum model would not provide our promising DM candidate. Thus, we minimally extend the model and find a good DM candidate. In the extended framework, we show the allowed regions to satisfy the muon anomalous magnetic moment and the observed relic density of dark matter in addition to predictions of the lepton sector. [ABSTRACT FROM AUTHOR]

Micro-mobility has become a mode of transportation since the 2010 s. Because this mode is relatively new, there are many unknowns, and the associated risks must be evaluated so they can be managed safely and effectively. This paper aims to introduce a decision support system (DSS) for ranking risk management alternatives in the micro-mobility sector under an interval-valued q-rung orthopair fuzzy (IVq-ROF) context. In this context, firstly IVq-ROF-interaction aggregation operators (AOs) are introduced for aggregating the information from IVq-ROF perspective. These AOs can provide a flexible mode to tackle realistic decision support problems within the IVq-ROF set (IVq-ROFS) context. Second, a definition of entropy and new entropies for IVq-ROFS is introduced. Third, a hybrid weight-determining formula is presented using an entropy-based weighting approach for the objective weight of criteria and a stepwise weight assessment ratio analysis (SWARA) method for the subjective weight of criteria. Fourth, the weighted integrated sum-product (WISP) approach is expanded from the IVq-ROF perspective. Further, the developed model is utilized in a case study of risk management alternative evaluation in the micro-mobility sector, which shows its applicability and feasibility under the IVq-ROF environment. Sensitivity and comparative investigations are studied to confirm the strength and stability of the obtained result. The best alternative has emerged as the state-private sector cooperation in successfully allocating the risk in the micro-mobility sector. The final results conclude that the developed methodology can provide more accurate decisions while considering multiple inducing indicators and input uncertainties. • A definition of entropy and new entropies for IVq-ROFS are introduced. • A hybrid weight-determining formula is presented. • The classic weighted sum-product (WISP) approach is expanded from IVq-ROFSs perspective. • A case study of risk allocation evaluation in the micro-mobility sector introduced. [ABSTRACT FROM AUTHOR]

Complications after anatomic (aTSA) and reverse (rTSA) total shoulder arthroplasty can be devastating to a patient's quality of life and require revisions that are costly to both the patient and the health care system. The purpose of this study is to determine the types, incidence, and timing of complications following aTSA and rTSA using an international database of patients who received a single-platform total shoulder arthroplasty system, in order to quantify the types of failure modes and the differences that occur between aTSA and rTSA. A total of 2224 aTSA (male-female, 1090:1134) and 4158 rTSA (male-female, 1478:2680) patients were enrolled in an international database of primary shoulder arthroplasty performed by 40 different surgeons in the United States and Europe. Adverse events and revisions reported for these 6382 patients were analyzed to identify the most common failure modes associated for both aTSA and rTSA. For the 2224 aTSA patients, 239 adverse events were reported for a complication rate of 10.7% and 124 revisions for a revision rate of 5.6%. The top 3 complications for aTSA were rotator cuff tear/subscapularis failure (n = 69; complication rate = 3.1%, revision rate = 1.9%), aseptic glenoid loosening (n = 55; complication rate = 2.5%, revision rate = 1.9%), and infection (n = 28; complication rate = 1.3%, revision rate = 0.8%). For the 4158 rTSA patients, 372 adverse events were reported for a complication rate of 8.9% and 104 revisions for a revision rate of 2.5%. The top 3 complications for rTSA were acromial/scapular fracture/pain (n = 102; complication rate = 2.5%, revision rate = 0.0%), instability (n = 60; complication rate = 1.4%, revision rate = 1.0%), and pain (n = 49; complication rate = 1.2%, revision rate = 0.2%). This large database analysis quantified complication and revision rates for aTSA and rTSA. We found aTSA and rTSA complication rates of 10.7% and 8.9%, respectively; with revision surgery rates of 5.6% and 2.5%, respectively. The 2 most common complications for each prosthesis type (aTSA: subscapularis/rotator cuff tears, aseptic glenoid loosening; rTSA: acromial/scapular fractures, instability) were unique to each device. The rate of infection was similar for both. Future prosthesis and technique development should work to mitigate these common complication types in order to reduce their rate of occurrence. [ABSTRACT FROM AUTHOR]

• The diversity of stakeholders involved will determine the role of the research team and the results of the action – research process. • Rural and urban contexts differ in terms of actors, challenges involved, design requirements and results. • Farmers are usually disconsidered in urban or desagrarized contexts and require specific power management strategies. • Public policies stakeholders are involved in more complex processes, in terms of stakeholders involved and type of results. • The dialogue between academia and farmers is a challenge when building horizontal processes, whatever the context is. [ABSTRACT FROM AUTHOR]

Purpose: To compare morphologic data of the talus using magnetic resonance images with previously reported values of the humeral head and the glenoid as a potential graft source for both the humeral head as well as glenoid reconstruction in the setting of concomitant glenoid and humeral head defects.Methods: All magnetic resonance images of the ankle were reviewed for assessment of the morphology and variation of the talus among individuals. Patients with post-traumatic, osteoarthritic, or surgical changes to the distal tibia about the mid- or hind- foot, or patients with incomplete medical records were excluded. Radiographic parameters that were measured included the maximum vertical height (MVH), the height to the talar neck, the radius of curvature (ROC) of the talar dome, ROC of the subtalar joint, and the maximum medial-to-lateral width of the talar dome. Demographic data also were collected on each individual. Statistical analysis was performed via a linear regression model with backwards elimination to determine which demographic data correlated most strongly with talar anthropometric values.Results: A total of 82 study patients met inclusion criteria (59 male, 23 female; mean age 40.91 ± 14.69 years). Sex was found have a positive correlation of the following talar dimensions: MVH (P = .039), talar dome ROC (P < .001), and subtalar joint ROC (p = 0.001). Height was the most positive correlation for medial-to-lateral width (P < .001), height to the talar neck (P = .004), and also correlate for MVH (P = .004). Body mass index was found to have multicollinearity and was therefore not used as a variable.Conclusions: Allograft talus appears to be a viable graft, as demonstrated in this anthropometric study for both reconstruction of the glenoid and humeral head when cases of bipolar glenohumeral bone loss are present.Clinical Relevance: This study aims to further evaluate potential allograft donor sites for bipolar lesions. [ABSTRACT FROM AUTHOR]

The exact relationship between body mass index (BMI) and internal rotation (IR) before and after total shoulder arthroplasty has not been studied to date. The purpose of this study was to determine the effects of BMI on the preoperative and postoperative shoulder range of motion and function in anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA), and specifically how IR affects patient ability to perform IR-related activities of daily living (ADLs). Patients from a prospective multicenter international shoulder arthroplasty registry who underwent primary rTSA (n=1171) and primary aTSA (n=883) were scored preoperatively and at latest follow-up (2-10 years, mean = 3 years) using the Simple Shoulder Test, University of California–Los Angeles shoulder score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Constant score, and Shoulder Pain and Disability Index patient-reported outcome measures (PROMs). Measured active abduction, forward flexion, IR, and active and passive external rotation were recorded, and BMI was evaluated as a predictor of motion and patient-reported outcomes. Patient responses to questions regarding the difficulty level of IR-related ADLs were studied. The relationships between BMI, IR, and ability to perform IR-related ADLs were quantified through analysis of variance with post hoc comparisons by Tukey honestly significant difference tests, where significance was denoted as P <.05. BMI was found to be inversely correlated with IR in patients undergoing both aTSA and rTSA, both preoperatively (P <.001 and P =.002) and postoperatively (P <.001 and P <.001). BMI affected the range of motion parameters of forward flexion abduction and external rotation but to a lesser extent than that of IR. Nonobese patients demonstrated significantly greater IR than overweight, obese, and morbidly obese patients postoperatively for aTSA (P <.001). For rTSA, nonobese patients had a significantly greater postoperative IR than obese and morbidly obese patients (P <.001 and P =.011, respectively). For both aTSA and rTSA patients, mean IR scores significantly differed between patients reporting normal function vs. patients reporting slight difficulty, considerable difficulty, or inability to perform IR-related ADLs. Increasing IR demonstrated a significant, positive correlation with all PROMs for both aTSA and rTSA patients (Pearson correlation, P <.001). BMI is an independent predictor of IR, even when controlling for age, gender, glenosphere size, and subscapularis repair. BMI was inversely correlated with the degree of IR, and decreased IR significantly negatively affected the ability to perform IR-related ADLs. Increasing BMI adversely affects shoulder ROM, particularly IR. IR is correlated with the ability to perform ADLs requiring IR in both aTSA and rTSA patients. [ABSTRACT FROM AUTHOR]

This study sought to determine, in patients undergoing percutaneous coronary intervention (PCI) during the work-up pre–transcatheter aortic valve replacement (TAVR): 1) the clinical and peri-procedural PCI characteristics; 2) the long-term outcomes; and 3) the clinical events in those patients with complex coronary features. A PCI is performed in about 25% of TAVR candidates, but procedural features and late outcomes of pre-TAVR PCI remain largely unknown. Multicenter study including 1197 consecutive patients who had PCI in the work-up pre-TAVR. A total of 1,705 lesions (1.5 ± 0.7 lesions per patient) were included. Death, stroke, myocardial infarction, and major adverse cardiovascular and cerebrovascular events (MACCE) were recorded, as well as target lesion failure (TLF) and target vessel failure (TVF). One-half of patients exhibited a multivessel disease and the mean SYNTAX (SYNergy between PCI with TAXUS and Cardiac Surgery) score was 12.1 ± 9.1. The lesions were of B2/C type, calcified, bifurcation, and ostial in 49.9%, 45.8%, 21.4%, and 19.3% of cases, respectively. After a median follow-up of 2 (interquartile range: 1 to 3) years, a total of 444 (37.1%) patients presented an MACCE. Forty patients exhibited TVF (3.3%), with TLF identified in 32 (2.7%) patients. By multivariable analysis, previous peripheral artery disease (p < 0.001), chronic obstructive pulmonary disease (p = 0.002), atrial fibrillation (p = 0.003), diabetes mellitus (p = 0.012), and incomplete revascularization (p = 0.014) determined an increased risk of MACCE. In patients with unprotected left main or SYNTAX score >32 (n = 128), TLF, TVF, and MACCE rates were 3.9%, 6.3%, and 35.9%, respectively (p = 0.378; p = 0.065, and p = 0.847, respectively, vs. the rest of the population). Patients undergoing PCI in the work-up pre-TAVR frequently exhibited complex coronary lesions and multivessel disease. PCI was successful in most cases, and TLF and TVF rates at 2-year follow-up were low, also among patients with high-risk coronary features. However, overall MACCE occurred in about one-third of patients, with incomplete revascularization determining an increased risk. These results should inform future studies to better determine the optimal revascularization strategy pre-TAVR. [ABSTRACT FROM AUTHOR]

Background: Preeclampsia (PE) is a frequently occurring multisystemic disease affecting ~5% of pregnancies. PE patients may develop HELLP syndrome (haemolysis, elevated liver enzymes, and low platelet), a mother and foetus life-threatening condition. Research into HELLP's genetic origin has been relatively unsuccessful, mainly because normal placental function and blood pressure regulation involve the fine-regulation of hundreds of genes.Objective: To identify new genes and mutations constituting potential biomarkers for HELLP syndrome.Study Design: The present case-control study involved whole-exome sequencing of 79 unrelated HELLP women. Candidate variants were screened in a control population constituted by 176 individuals. Stringent bioinformatics filters were used for selecting potentially etiological sequence variants in a subset of 487 genes. We used robust in silico mutation modelling for predicting the potential effect on protein structure.Results: We identified numerous sequence variants in genes related to angiogenesis/coagulation/blood pressure regulation, cell differentiation/communication/adhesion, cell cycle and transcriptional gene regulation, extracellular matrix biology, lipid metabolism and immunological response. Five sequence variants generated premature stop codons in genes playing an essential role in placental physiology (STOX1, PDGFD, IGF2, MMP1 and DNAH11). Six variants (ERAP1- p.Ile915Thr, ERAP2- p.Leu837Ser, COMT-p.His192Gln, CSAD-p.Pro418Ser, CDH1- p.Ala298Thr and CCR2-p.Met249Lys) led to destabilisation of protein structure as they had significant energy and residue interaction-related changes. We identified at least two mutations in 57% of patients, arguing in favour of a polygenic origin for the HELLP syndrome.Conclusion: Our results provide novel evidence regarding PE/HELLP's genetic origin, leading to new biomarkers, having potential clinical usefulness, being proposed. [ABSTRACT FROM AUTHOR]

Postoperative infectious complications after a pancreaticoduodenectomy remain a significant cause of morbidity. Studies have demonstrated that a preoperative biliary stent increases the risk of postoperative infectious complications. Few studies have investigated the specific preoperative biliary stent bacterial sensitivities to preoperative antibiotics and the effect on infectious complications. The goal of this study was to investigate if the presence of a preoperative biliary stent increases the risk of postoperative infectious complications in patients undergoing a pancreaticoduodenectomy. Additionally, we aimed to investigate biliary stent culture sensitivities to preoperative antibiotics and determine if those sensitivities impacted postoperative infectious complications after a pancreaticoduodenectomy. A retrospective chart review of patients who had undergone a pancreaticoduodenectomy at a single institution tertiary care center from 2007 to 2018 was performed. Perioperative variables including microbiology cultures from biliary stents were collected and analyzed. A total of 244 patients underwent a pancreaticoduodenectomy. A preoperative biliary stent was present in 45 (18%) patients. Infectious complications occurred in 25% of those patients with a preoperative biliary stent, and 19% of those without (P =.37). Of those patients with a stent that was cultured intraoperatively, 92% grew bacteria and 61% of those were resistant to the preoperative antibiotics administered. Of the patients with a preoperative biliary stent and bacteria resistant to the preoperative antibiotics, 17% developed a postoperative infectious complication, compared with 20% if the bacteria cultured was susceptible to the preoperative antibiotics (P =.64). Infectious complications after pancreaticoduodenectomy are a significant cause of morbidity. Stent bacterial sensitivities to preoperative antibiotics did not reduce the postoperative infectious complications in the preoperative biliary stent group suggesting a multifactorial cause of infections. [ABSTRACT FROM AUTHOR]

Obtaining postoperative laboratory studies after primary reverse shoulder arthroplasty (RSA) is a common practice. However, justification of this practice remains unclear. This study assesses the utility of routine postoperative laboratory studies in RSA. The electronic medical records of 369 patients who underwent RSA over 10 years were retrospectively reviewed. A total of 213 patients qualified for analysis. Primary outcomes were intervention related to abnormal laboratory values, length of stay, and 90-day emergency department visits/readmissions. Multivariate logistic regression analysis was performed to identify risk factors associated with abnormal laboratory values and postoperative visits/readmissions. Of 213 patients analyzed, 188 (88.7%) had abnormal postoperative laboratory values: 69% had an abnormal hemoglobin (Hgb) or hematocrit level, but only 12% underwent interventions. Lower preoperative Hgb was a significant predictor of receiving a transfusion. A significant association existed between abnormal postoperative electrolyte and creatinine levels with lower body mass index (BMI) and higher Charlson Comorbidity Index (CCI). Only 4 patients (1.8%) received non–transfusion related intervention. Emergency department visits were not statistically different between patients with positive or negative laboratory tests (P =.73). Because 87.3% of laboratory studies did not influence patient management, we recommend against routine testing for primary RSA. This study demonstrates that the practice of obtaining routine postoperative laboratory studies is not justified. We recommend selectively obtaining a postoperative basic metabolic profile in patients with increased American Society of Anesthesiologists classification and/or CCI with a lower BMI. We also recommend selectively ordering postoperative complete blood count in patients with a lower preoperative Hgb. [ABSTRACT FROM AUTHOR]

Oral lichen planus (OLP) is a chronic inflammatory disease with a strong immune mechanism involved. Although no causal factor is identified in OLP, a cellular hypersensitivity has been associated with its pathophysiology. Furthermore, the chronicity of the disease could cause its malignant transformation. Herein, we present a literature review focusing on the interrelationship of Toll-like receptors (TLRs) and OLP, mainly on the molecular behavior of oral keratinocytes once TLR signals are activated. A family of transcription factors, the Interferon Regulatory Factor (IRF) family, could be having a novel role in the prognosis of OLP. Specifically, Interferon Regulatory Factor 6 (IRF6) as a key component of the TLR signaling could impart specificity to downstream responses in oral keratinocytes. We propose a hypothetical model after TLR2 activation in which a plausible TLR2-IRF6 regulatory mechanism could be a key factor to be evaluated in OLP as a convenient chronic inflammatory model. Further molecular studies are required to fully understand the role of oral keratinocytes in the initiation of OLP. • The pathophysiology of OLP involves both types of immunity: innate and adaptive. • Innate immunity is responsible for the onset and establishment of OLP. • TLRs are essential in the innate immune response of oral keratinocytes. • IRF6 might regulate expression of pro-inflammatory cytokines in oral keratinocytes. • A TLR2-IRF6 regulatory mechanism could be a key factor to be evaluated in OLP. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to determine if there are significant side-to-side anthropometric differences between paired glenoids.Methods: Forty-six matched-pair cadaver glenoids were harvested, and their glenoid heights (GHs) and glenoid widths (GWs) were measured with digital calipers. The glenoid surface area was calculated using the standard assumption that the inferior two-thirds of the glenoid is a perfect circle.Results: There was a statistically significant difference between matched-pair GHs of 0.96 ± 3.07 mm (P = .020) and GWs of 0.46 ± 1.64 mm (P = .033). There was a significant difference of glenoid cavity area of 20.30 ± 81.53 mm2 (P = .044), or a difference of ∼3%. A total of 4 of 46 pairs of glenoids (8.6%) showed a difference in width >3 mm.Conclusions: This study demonstrates the fallacy of use of the contralateral glenoid in measuring glenoid bone loss. Although many paired samples exhibited similar side-to-side glenoid measurements, the number of cadaveric pairs that showed differences of >3 mm was substantial. Caution should be taken when using calculation methods that include this assumption for surgical decision making, as surface area, GW, and GH were all shown to have statistically significant side-to-side differences in their measurements.Clinical Relevance: Many methods exist for measuring glenoid bone loss after anterior shoulder dislocation, but some of the current methods may be inaccurate and lead to unreliable estimations. [ABSTRACT FROM AUTHOR]

Purpose: To compare screw insertional torque and coracoid-glenoid compression from 4 fixation techniques with different screw design parameters and cortical augmentation for the Latarjet procedure.Methods: Simulated Latarjet procedures were performed with 4 fixation techniques using laminated polyurethane blocks with dimensions similar to the coracoid-glenoid construct. The groups included DePuy Synthes Mitek 3.5-mm partially threaded screws with top hats, Arthrex 3.75-mm fully threaded screws with a 2-hole plate, Arthrex 3.75-mm fully threaded screws, and Smith & Nephew 4.0-mm partially threaded screws. Screws were inserted using a digital torque-measuring screwdriver to determine maximum insertional torque. Pressure-sensitive film was used to measure the maximum contact pressure and the effective pressure distribution (EPD) between the coracoid and glenoid; the EPD represents the percentage of the film's surface area that experienced pressure greater than 10 MPa. One-way analysis of variance and post hoc tests were used for statistical analysis.Results: Significant differences were found between the 4 fixation groups for each variable measured. The 2 cortically augmented systems produced significantly higher maximum insertional torque than the non-cortically augmented systems (P < .001 for both). The 3.75-mm screws with a 2-hole plate yielded significantly higher contact pressures than the 4.0-mm screws (P = .028). This group also had a high EPD, with a mean value more than double the values of the non-cortically augmented systems (P = .037 and P < .001).Conclusions: Cortically augmented fixation methods showed higher maximum insertional torque, maximum contact pressure, and EPD between the surfaces of the coracoid and glenoid in this Sawbones model.Clinical Relevance: Various implants are available for the Latarjet procedure, but their biomechanical characteristics have not yet been fully elucidated. Graft fracture and nonunion represent 2 modes of failure that may be related to insertional torque and coracoid-glenoid compression. This study compared screw insertional torque and compression achieved using 4 fixation techniques with different screw design parameters and cortical augmentation in a Sawbones model. [ABSTRACT FROM AUTHOR]

Purpose: To assess the accuracy of measuring glenoid version on magnetic resonance imaging (MRI) in the presence of varying amounts of the medial scapula body as compared with the gold standard of glenoid version measured on computed tomography (CT) imaging, including the entire scapula in a cohort of young patients with shoulder instability and without glenohumeral arthritis.Methods: A retrospective review was performed on instability patients with preoperative MRI and CT imaging. Measurements of available scapular width and glenoid version were performed using the Cobb angle method to measure the angle between the plane of the glenoid fossa to Friedman's line on axial images. Intra- and interrater reliability analysis was performed using intraclass correlation coefficients to assess agreement between MRI and CT measurements. Paired t tests were used to compare measurement differences between MRI and CT.Results: Thirty-two patients with both MRI and CT scans were assessed. Intra- and inter-rater assessment revealed strong agreement for scapular width measurement. For glenoid version measurement, intra-rater agreement was excellent and inter-rater agreement was moderate on CT and good on MRI. The mean available scapular body width was 24.7 mm longer on CT as compared with MRI (95% confidence interval 17.5-31.9, P < .0001; 109.8 ± 8.2 mm vs 85.1 ± 16.9 mm, respectively), with MRI having an average of 78.2% (±17.6%) of the CT scapular width shown on CT. No significant difference in glenoid version was found between MRI and CT (95% confidence interval -0.87 to 1.75, P = .499; MRI -2.57° vs CT -2.13°).Conclusion: MRI provided significantly shorter available scapular widths when compared with CT imaging in a cohort of patients with glenohumeral instability and without arthritis. However, this failed to produce a significant difference of ≥5° in measured glenoid version compared with CT measurements when 75% (8 cm) of the scapular width was present on MRI. Measuring glenoid version on MRI does not appear to be significantly affected when the entirety of the medial border of the scapula is not included in the imaging field.Level Of Evidence: Level III; study of diagnostic test. [ABSTRACT FROM AUTHOR]

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Purpose: To establish the accuracy and reliability of the circle-line method (CLM) of measuring glenoid bone loss; to compare the CLM calculation with a traditionally used method of calculating a ratio; and to evaluate surgeons' ability to estimate the amount of glenoid bone loss before performing any calculations.Methods: Three-dimensional reconstructions of computed tomography scans of consecutive patients with anterior instability and glenoid bone loss were reviewed by 13 surgeons blinded to the diagnosis. The reviewers made estimations of bone loss before creating any measurements by viewing the available computed tomography scan as well as the 3-dimensional reconstructions. They selected an en face view of the glenoid to create a best-fit circle. Bone loss calculation with a traditional linear method as well as a CLM calculated by algebraic geometry was completed. The CLM requires calculation of the diameter of a best-fit circle on the glenoid, as well as the length of a single line along the circle representing the line of bone loss. All methods were compared with a computerized method of tracing the area of the glenoid within a best-fit circle. Interobserver and intraobserver calculations were performed. Analysis-of-variance testing was used to compare the estimates of bone loss versus the CLM-calculated bone loss. Tukey post hoc analysis was used to define the accuracy of the CLM calculation compared with a more traditional method of calculating bone loss.Results: Bone loss estimations were significantly different from CLM-calculated bone loss in all cases except those with greater than 25% bone loss. The CLM was more accurate in all types of bone loss except cases of greater than 25% bone loss. Interobserver reliability was very good for the glenoid diameter measurement and moderate for the CLM. Intraobserver reliability ranged from moderate to good for all methods of measurement.Conclusions: Surgeon estimations of glenoid bone loss, as well as traditional line-measurement calculations, are inconsistent and unreliable for accurate determination of the optimal surgical treatment for anterior shoulder instability. The CLM is a simple, reproducible, and accurate method for determining glenoid bone loss and does not require specialized software or imaging protocols.Level Of Evidence: Level II, diagnostic study. [ABSTRACT FROM AUTHOR]

This work explores resource recovery coupled to seawater desalination in small islands. As small islands depend on seawater desalination for water access, they make an excellent ground for exploring the trade-offs associated to resource recovery, like potential economic gains, energy use, and environmental impacts. Here, we investigated these tensions in the context of Lampedusa, in Italy. We then developed and evaluated scenarios for the recovery of additional water, Mg, and other resources from brines, to identify if and how resource recovery is an interesting approach for the island vis-à-vis these tensions. We have found that the potential to increase water production with water recovery from brine is an interesting alternative for small islands, especially when harnessing waste heat. However, while some technologies offer possibilities for recovering additional resources, in places like small islands the potential benefits from additional recovery do not seem to justify the costs to the local system. [Display omitted] [ABSTRACT FROM AUTHOR]

Persons with infectious Mycobacterium tuberculosis (MTB) pose a significant risk to others in crowded areas, such as emergency department (ED) waiting rooms. After a slow response to a first MTB exposure was associated with poor compliance with post-exposure MTB testing, we sought to determine if a more expedient response would improve compliance with post-exposure testing. We compared two large MTB exposures occurring six months apart in the ED of an acute care academic hospital. Exposed patients and accompanying guests were contacted by phone and certified mail and offered baseline and follow-up QuantiFERON-TB Gold (QFT) tests, obtained 10-12 weeks apart. In the first exposure investigation, a positive MTB PCR test resulted three days after an infectious patient presented to the ED. Sixty-one non-staff were identified as potentially exposed (39 patients + 22 guests). Exposed persons were notified by telephone starting 16 days post-exposure. In the second exposure investigation, 90 non-staff exposures were identified (54 patients + 36 guests). Exposed persons were notified starting six days post-exposure. Baseline QFT testing was obtained by 30/61 (49%) and 39/90 (43%) persons in the first exposure and second exposures, respectively (p=0.48). Follow-up QFT testing was obtained by 13/61 (21%) and 17/90 (19%) in the first and second exposures, respectfully (p=0.68). 38/76 (50%) of exposed persons who were contacted directly by telephone obtained QFT testing, while 3/14 (21%) of persons only contacted indirectly (voicemail or certified mail) obtained QFT testing (p=0.049). A more expedient response did not have an impact on post-exposure QFT test compliance. Direct communication was associated with a statistically greater likelihood of persons following through with post-exposure testing. A greater focus on initiating direct contact via telephone and communicating that two QFT tests are needed may be essential to compliance with post-exposure MTB testing. [ABSTRACT FROM AUTHOR]

Urine cultures (UCX) are frequently sent for diagnostic work-up of fevers, even when little else suggests there is a urinary tract infection (UTI). Yet, UCXs are very easily contaminated, often misleading caregivers. In normal hosts, it is very unlikely that a patient has a UTI, even if their UCX shows growth, unless there is concomitant inflammation/increased white blood cells (WBC) in the urine. Urinalysis (UA) measures urine WBCs and can be used to screen if urine should be reflexed for UCX. With rare exception, UA with ≤5 WBCs/high-powered field (HPF) need not be reflexed for UCX, while UA with>10 WBCs/HPF should be reflexed for UCX. We sought to determine if UAs with 6-10 WBCs/HPF were likely to have significant bacterial growth reflecting an underlying UTI. We conducted a multicenter retrospective study of all UAs with reflex UCX from 10/01/2019-10/31/2020. All UAs found to have 6-10 WBCs per HPF and associated UCXs were examined. Clinical charts were reviewed for evidence to support/dismiss UTIs. 39,855 urine specimens were reviewed. 2,275 met inclusion criteria. Only 77 (3.4%) were flagged as "abnormal" UCXs. Chart review ruled out UTIs in all but 20 (0.9%) cases. 2,198 (99.6%) urines either had no growth (1,593 - 70.0%), scant growth (353 - 15.5%) or other findings consistent contaminated cultures (252 - 11.1%). The overwhelming majority of urine specimens with 6-10 WBCs were unlikely to have an UTI and did not require reflex UCX. Decreasing the number of urine specimens that are reflexed to UCX would decrease unnecessary resource utilization in the lab and help reduce the number of misleading contaminated UCXs not from true UTIs. This could help to improve antibiotic stewardship, reduce antibiotic resistance pressures, reduce hospital onset C. difficile infection, and some cases with Foley catheters would no longer be reported as catheter-associated UTIs. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether characteristics such as age, height, weight, sex, or body mass index affected the distal tibial dimensions and radius of curvature (ROC) of a potential donor for anterior glenoid augmentation.Methods: A retrospective review of magnetic resonance imaging of ankles without bony trauma was performed, and the anteroposterior (AP) and medial-lateral (ML) distances and ROC of the tibial plafond articular surface were measured. Demographic characteristics, including age, sex, height, weight, and body mass index, were recorded.Results: A total of 141 imaging studies were included (73 men and 68 women; average age, 38.2 ± 12.65 years). All potential specimens accommodated harvest of a 10 × 22-mm distal tibial allograft bone block. Men had greater ML (42.74 cm [95% confidence interval (CI), 42.09-43.39 cm] vs 38.01 cm [95% CI, 37.30-38.72 cm]; P < .001) and AP (38.16 cm [95% CI, 37.47-38.85 cm] vs 34.57 cm [95% CI, 33.97-35.17 cm]; P < .001) dimensions. Significant moderately positive correlations were found for AP dimensions with height (r = 0.584, P < .001) and weight (r = 0.383, P < .001) and for ML dimensions with height (r = 0.711, P < .001) and weight (r = 0.467, P < .001). ROC was positively correlated with height (r = 0.509, P < .001) and weight (r = 0.294, P < .001). Patient age was not related to either the AP or ML distal tibial dimensions or ROC.Conclusions: After magnetic resonance imaging analysis, all potential donors permitted harvest of a standard-sized distal tibial allograft irrespective of sex or common anthropometric measures, and 85.8% showed distal tibial morphology acceptable for glenoid augmentation. AP and ML graft dimensions and ROC correlated significantly with height and weight.Level Of Evidence: Level II, diagnostic study. [ABSTRACT FROM AUTHOR]

Plasminogen and plasmin are fundamental components of the fibrinolytic system that interact with microorganisms generating different immunopathological effects. The molecules of Mycobacterium tuberculosis interplaying with plasminogen have already been identified and characterized. In this work, we studied the effects of plasmin(ogen) bound to Mycobacterium bovis Calmette-Guérin (BCG) on phagocytosis in THP1 macrophages as well as in granuloma formation and development on in vitro human granuloma model. For this purpose, BCG was coated with plasminogen and plasmin, obtained after activation of zymogen by tissue plasminogen activator. The results showed a significant reduction in the number of bacteria phagocytosed by macrophages in presence of plasminogen or plasmin on BCG surface. On the other hand, at 3 days BCG/plasminogen/plasmin induced an increase granuloma numbers with respect to those induced by uncoated bacteria. BCG/plasminogen/environments also showed a significant increase of IL-6 secretion. At 7 days, a reduced number of granulomas and an increased number of bacteria was observed with respect to uncoated BCG environment. Altogether, these results showed that plasmin(ogen) on the mycobacterial surface affects phagocytosis, granuloma development and the cytokine context, thus resulting in an increased number of bacteria in granulomas. [ABSTRACT FROM AUTHOR]

• Seaweed has potential as source of functional ingredients for glycemic control. • Selective inhibition of enzymes could optimize the homeostasis of glycaemia. • Seaweed's non-extractable polyphenols are a promissory still little explored group. • Design of functional food requires multidisciplinary efforts to cover all aspects. Several aspects of foods affect starch digestion and glycemic response, including food's physical/chemical structure and the presence of anti-enzymatic compounds. The complex relationship between food properties, metabolism and diseases implies that designing foods with a consistent lower glycemic response turn challenging. Edible seaweeds are rich in several bioactive compounds -particularly polyphenols-, which can be used to develop new low glycemic response foods. This paper reviews what is known about functional ingredients found in seaweeds that may help to design lower glycemic response foods through mainly the inhibition of digestive enzymes related with the breakdown of glycemic carbohydrates. A global viewpoint is exposed, covering aspects related with seaweed's polyphenols composition and application of such compounds to design new products. [ABSTRACT FROM AUTHOR]

Summary Introduction Perioperative microsurgical planning increases the likelihood of successful results. Augmented reality (AR) is the addition of artificial information to allow the user to perform tasks more efficiently. The aim of our study is to report the use of AR for microsurgical planning with a smartphone (ARM-PS) as a dissection route map. Patients and methods AR was used for superficial circumflex iliac artery perforator (SCIP) flap planning. Three-dimensional (3D) reconstruction images of the inguinal and lower abdomen vascular anatomy were obtained by computed tomography angiography. These 3D images were imported to a smartphone and an AR app was used to superimpose them with the camera. The drawings performed with ARM-PS were correlated with handheld Doppler and intraoperative findings. Results The correlation of ARM-PS drawings with handheld Doppler results was 100% for superficial inferior epigastric artery (SIEA) and superficial and deep branches of SCIP in 60 inguinal areas studied. Intraoperative findings matched perfectly in all 30 cases with ARM-PS drawings for the location of the mentioned vessels and lymph nodes. Flap harvest time decreased in 20% compared with our traditional timing. Conclusions ARM-PS is an easy, noninvasive, and accurate method that provides a dissection route map, thereby standardizing flap harvesting, and shows a perfect correlation with intraoperative findings. It reduces operating time and may improve operative results, thus decreasing donor site morbidity. [ABSTRACT FROM AUTHOR]