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Children and young people with a social worker (CYPwSW) have particular mental health profiles and needs. Research indicates that despite having higher levels of mental health distress this group tend to experience inequitable access to specialist mental health services. Therefore, much of their mental health support currently falls to generalists including paediatricians. We are currently undertaking a four-year study the CAMHS Referrals and Outcomes for Adolescents and Children with Social Workers (COACHES). Here we present initial insights from an analysis of 20,166 unique case notes which identified 1) High thresholds for entry to CAMHS 2) A requirement that young people must be perceived as stable prior to accessing services 3) that young people often did not feel that their voices were taken seriously 4) the importance of time for trust. Based off these findings and expert-by-experience's insights, we conclude by suggesting ways that paediatricians and health care professionals can best support CYPwSW. These include being the 'connective tissue' around young people's support network, gently and proactively building relationships, redressing power imbalances and supporting transitions to adulthood. [ABSTRACT FROM AUTHOR]

Pes planus occurs due to the loss of the longitudinal arch of the foot, resulting in altered gait mechanics. This may lead to increased complications following total hip arthroplasty (THA). Thus, the aim of this study was to assess the effects that pes planus has on rates of falls, implant complications, fall-related injuries, and times to revision among THA patients. A retrospective review of a private insurance claims database was conducted from 2010 to 2021. Patients who had a diagnosis of congenital or acquired pes planus and cases of THA were identified. Patients undergoing THA with a diagnosis of pes planus were matched to control patients 1:5 based on age, sex, and comorbidity profiles. Logistic regression was utilized to assess for differences in complication rates. A total of 3,622 pes planus patients were matched to 18,094 control patients. The pes planus group had significantly higher rates of falls than the control group (6.93 versus 2.97%, OR [odds ratio]: 2.43; CI [confidence interval]: 2.09 to 2.84; P <.001). Pes planus patients also had significantly greater odds of dislocation (OR: 1.89; CI: 1.58 to 2.27; P <.001), mechanical loosening (OR: 2.43; CI: 2.09 to 2.84; P =.019), and periprosthetic fracture (OR: 2.43; CI: 2.09 to 2.84; P <.001). The pes planus group had significantly greater rates of proximal humerus fractures (P =.008), but no difference was seen in distal radius fractures (P =.102). The time to revision was significantly shorter in the pes planus group (190 versus 554 days, P <.001). Pes planus in patients undergoing THA is associated with increased risk of complications and faster time to revision. These findings may allow orthopaedic surgeons to identify those patients at risk and allow for more educated patient counseling and operative planning. [ABSTRACT FROM AUTHOR]

Superior augment use may help avoid superior tilt while minimizing removal of inferior glenoid bone. Therefore, our goal was to compare superior augments vs. no-augment baseplates in reverse shoulder arthroplasty (RSA) for patients with rotator cuff dysfunction and no significant superior glenoid erosion. A multicenter retrospective analysis of 145 patients who underwent RSA with intraoperative navigation (Equinoxe GPS; Exactech) and 3-year follow-up (mean 32 months' follow-up, range 20-61 months) who had preoperative superior inclination less than 10° and retroversion less than 15°. Patient demographics, radiographic measurements, surgical characteristics, patient-reported outcomes at preoperative and postoperative visit closest to 3 years, and adverse events at final follow-up were obtained. Operative time, planned inclination, and planned version of the baseplate were obtained. χ2 test was used to compare categorical variables, and Student t test was used to compare the augment and no-augment cohorts. The study population consisted of 54 superior augment patients and 91 no-augment patients. The augment cohort had lower body mass index (27.2 vs. 29.4, P =.023) and higher native superior inclination (5.9° vs. 1.4°, P <.001). No difference between the augment and no-augment cohorts was found regarding age (P =.643), gender (P =.314), medical comorbidities (P >.05), surgical indication (P =.082), and native glenoid version (P =.564). The augment cohort had higher internal rotation score (4.6 vs. 3.9, P =.023), and all remaining range of motion (ROM) and patient-reported outcomes (PROs) preoperatively were not significantly different. At final follow-up, active ROM in all planes was not different between the cohorts. Regarding PROs, the postoperative Shoulder Arthroplasty Smart score was significantly higher (78.0 vs. 73.6, P =.042), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score trended toward higher (83.6 vs. 77.5, P =.063) in the augment cohort. The augment cohort had a significantly lower proportion of patients who planned to have superior baseplate tilt (1.9% vs. 14.3%, P =.012) and had greater mean inclination correction (6.3° vs. 1.3°, P <.001), compared with the no-augment cohort. Adverse events were rare, and there was no significant difference found between the augment and no-augment cohorts (5.6% vs. 3.3%, P =.509). Superior augmented baseplate in RSA with minimal superior glenoid erosion is associated with similar ROM and adverse events with somewhat improved postoperative PROs compared with nonaugmented baseplates at the 3-year follow-up. Additionally, superior augments resulted in a greater proportion of baseplates planned to avoid superior tilt, and trended toward shorter operative times. Further investigation of long-term glenoid baseplate loosening is imperative to fully understand the cost-effectiveness of superior augments in the setting of minimal glenoid deformity. [ABSTRACT FROM AUTHOR]

Although the Favard classification is commonly utilized by surgeons to describe the supero-inferior morphology of the glenoid when treating rotator cuff arthropathy (RCA), its utility in prognosticating patients' clinical state before and after reverse shoulder arthroplasty (RSA) remains unproven. We assessed the prognostic value of the Favard glenoid classification on preoperative clinical state and postoperative clinical and radiographic outcomes in RSA. A prospectively collected, multicenter database for a single-platform shoulder arthroplasty system was queried for patients with RCA who underwent RSA with a minimum 2-year clinical follow-up. Differences in patient reported outcome scores (PROMs) (Simple Shoulder Test, American Shoulder and Elbow Surgeons, Shoulder Pain and Disability Index, visual analog scale pain, Shoulder Function score), combined patient-reported and clinical-input scores (Constant, University of California Los Angeles, Shoulder Arthroplasty Smart), active range of motion values (forward elevation, abduction, external rotation [ER], internal rotation [IR]), radiographic outcomes (humeral radiolucency line rates, scapular notching rate), and the incidence of postoperative complications and revision surgery were compared by glenoid deformity type per the Favard classification. Comparisons were performed to assess the ability of the Favard classification to prognosticate the preoperative, postoperative, and improved state after RSA. 400 RSAs performed for RCA were included. Comparison of outcomes between Favard glenoid types resulted in 6 pairwise comparisons of 12 clinical outcome metrics, yielding 72 total Favard glenoid pairwise comparisons for each clinical state (preoperative, postoperative, improvement). Of the 216 possible pairwise Favard glenoid type/metric comparisons, statistical significance was only reached for 3% of the combinations (7/216). Among E0, E1, and E2 glenoids, the only statistically significant pairwise comparison identified among all three clinical states was a more favorable preoperative American Shoulder and Elbow Surgeons score for E0 vs. E2 glenoids. Preoperatively, E3 glenoids had poorer ER, IR, and Shoulder Arthroplasty Smart scores compared to E0 glenoids and poorer ER compared to E2 glenoids. Postoperatively, E3 glenoids had a poorer IR score compared to E0 glenoids and poorer ER compared to E1 glenoids. No pairwise differences in preoperative to postoperative improvement were found. There were no statistically significant pairwise differences in humeral lucency rate, scapular notching rate, complication rates, or revision rates between Favard glenoid types. Although useful for describing degenerative changes to the glenohumeral joint, the Favard classification offers little prognostic information regarding patient outcomes before and after RSA aside from poorer preoperative and postoperative axial rotation in E3 glenoids. Alternative glenoid classification systems or predictive models should be considered for more precise prognoses of patients undergoing RSA for RCA. [ABSTRACT FROM AUTHOR]

Clinical significance, as opposed to statistical significance, has increasingly been utilized to evaluate outcomes after total shoulder arthroplasty (TSA). The purpose of this study was to identify thresholds of the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) for TSA outcome metrics and determine if these thresholds are influenced by prosthesis type (anatomic or reverse TSA), sex, or preoperative diagnosis. A prospectively collected international multicenter database inclusive of 38 surgeons was queried for patients receiving a primary aTSA or rTSA between 2003 and 2021. Prospectively, outcome metrics including ASES, shoulder function score (SFS), SST, UCLA, Constant, VAS Pain, shoulder arthroplasty smart (SAS) score, forward flexion, abduction, external rotation, and internal rotation was recorded preoperatively and at each follow-up. A patient satisfaction question was administered at each follow-up. Anchor-based MCID, SCB, and PASS were calculated as defined previously overall and according to implant type, preoperative diagnosis, and sex. The percentage of patients achieving thresholds was also quantified. A total of 5851 total shoulder arthroplasties (TSAs) including aTSA (n = 2236) and rTSA (n = 3615) were included in the study cohort. The following were identified as MCID thresholds for the overall (aTSA + rTSA irrespective of diagnosis or sex) cohort: VAS Pain (−1.5), SFS (1.2), SST (2.1), Constant (7.2), ASES (13.9), UCLA (8.2), SPADI (−21.5), and SAS (7.3), Abduction (13°), Forward elevation (16°), External rotation (4°), Internal rotation score (0.2). SCB thresholds for the overall cohort were: VAS Pain (−3.3), SFS (2.9), SST 3.8), Constant (18.9), ASES (33.1), UCLA (12.3), SPADI (−44.7), and SAS (18.2), Abduction (30°), Forward elevation (31°), External rotation (12°), Internal rotation score (0.9). PASS thresholds for the overall cohort were: VAS Pain (0.8), SFS (7.3), SST (9.2), Constant (64.2), ASES (79.5), UCLA (29.5), SPADI (24.7), and SAS (72.5), Abduction (104°), Forward elevation (130°), External rotation (30°), Internal rotation score (3.2). MCID, SCB, and PASS thresholds varied depending on preoperative diagnosis and sex. MCID, SCB, and PASS thresholds vary depending on implant type, preoperative diagnosis, and sex. A comprehensive understanding of these differences as well as identification of clinically relevant thresholds for legacy and novel metrics is essential to assist surgeons in evaluating their patient's outcomes, interpreting the literature, and counseling their patients preoperatively regarding expectations for improvement. Given that PASS thresholds are fragile and vary greatly depending on cohort variability, caution should be exercised in conflating them across different studies. [ABSTRACT FROM AUTHOR]

To examine the perioperative, postoperative, and long-term outcomes of fenestrated/branched endovascular aneurysm repair (F/BEVAR) in octogenarians compared with nonoctogenarians. A multicenter, retrospective cohort study was conducted using the Vascular Quality Improvement database, which prospectively captures information on patients who undergo vascular surgery across 1021 academic and community hospitals in North America. All patients who underwent F/BEVAR endovascular aortic repair from 2012 to 2022 were included. Patients were stratified into two groups: those aged <80 years and those aged ≥80 years at the time of the procedure. The preoperative, intraoperative, and postoperative factors were compared between the two groups. The primary outcome was long-term all-cause mortality; secondary outcomes included aortic-specific mortality and aortic-specific reintervention. A total of 6007 patients (aged <80 years, n = 4860; aged ≥80 years, n = 1147) who had undergone F/BEVAR procedures were included. No significant difference was found in technical success, postoperative length of stay, length of intensive care unit stay, postoperative bowel ischemia, and spinal cord ischemia. After adjustment for baseline covariates, octogenarians were more likely to suffer from a postoperative complication (odds ratio [OR]: 1.16; [95% confidence interval (CI): 0.98-1.37], P <.001) and be discharged to a rehabilitation center (OR: 1.60; [95% CI: 1.27-2.00], P <.001) or nursing home (OR: 2.23; [95% CI: 1.64-3.01], P <.001). Five-year survival was lower in octogenarians (83% vs 71%, hazard ratio [HR]: 1.70; [95% CI: 1.46-2.0], P <.0001). Multivariate Cox proportional hazard analysis demonstrated that age was associated with increased all-cause mortality (HR: 1.72, [95% CI: 1.39-2.12], P <.001) and aortic-specific mortality (HR: 1.92, [95% CI: 1.04-3.68], P =.038). Crawford extent II aortic disease was associated with an increase in all-cause mortality (HR 1.49; [95% CI: 1.01-2.19], P <.001), aortic-specific mortality (HR: 5.05; [95% CI: 1.35-18.9], P =.016), and aortic-specific reintervention (HR: 1.91; [95% CI: 1.24-2.93], P =.003). Functional dependence was associated with increased all-cause mortality (HR: 2.90; [95% CI: 1.87-4.51], P <.001) and aortic-specific mortality (HR: 4.93; [95% CI: 1.69-14.4], P =.004). Our findings suggest that octogenarians do have a mildly increased mortality rate and rate of adverse events after F/BEVAR procedures. Despite this, when adjusted for other risk factors, age is on par with other medical comorbidities and therefore should not be a strict exclusion criterion for F/BEVAR procedures, rather considered in the global context of patient's aortic anatomy, health, and functional status. [ABSTRACT FROM AUTHOR]

The multisource surveillance tool (MUST) is a platform for collecting, gathering, and visualizing different sources of information related to health events and highly pathogenic avian influenza in mammals (HPAIM). MUST-AI constitutes the first part of the MUST tool, which centralizes health information relating to cases of HPAIM since January 1, 2021, and comes from 3 different notification sources, an official notification source confirmed by public health institutions (i.e., WAHIS) and two other alternative unofficial sources that collect events from online media (PADI-web) and expert networks (ProMED). Owing to the use of natural language processing (NLP) algorithms, HPAIM events are represented on an interactive map associated with a graph that represents their distribution over a given time interval. This paper presents new tools and approaches for data fusion and experiments for selecting data to integrate into MUST that are related to HPAIM events. [ABSTRACT FROM AUTHOR]

The aim of this study was to facilitate preoperative identification of patients at risk for dislocation after reverse total shoulder arthroplasty (rTSA) using the Equinoxe rTSA prosthesis (medialized glenoid, lateralized onlay humerus with a 145° neck-shaft angle) and quantify the impact of accumulating risk factors on the occurrence of dislocation. We retrospectively analyzed 10,023 primary rTSA patients from an international multicenter database of a single platform shoulder prosthesis and quantified the dislocation rate associated with multiple combinations of previously identified risk factors. To adapt our statistical results for prospective identification of patients most at-risk for dislocation, we stratified our data set by multiple risk factor combinations and calculated the odds ratio for each cohort to quantify the impact of accumulating risk factors on dislocation. Of the 10,023 primary rTSA patients, 136 (52 female, 83 male, 1 unknown) were reported to have a dislocation for a rate of 1.4%. Patients with zero risk factors were rare, where only 12.7% of patients (1268 of 10,023) had no risk factors, and only 0.5% of these (6 of 1268) had a report of dislocation. The dislocation rate increased in patient cohorts with an increasing number of risk factors. Specifically, the dislocation rate increased from 0.9% for a patient cohort with 1 risk factor to 1.0% for 2 risk factors, 1.6% for 3 risk factors, 2.7% for 4 risk factors, 5.3% for 5 risk factors, and 7.3% for 6 risk factors. Stratifying dislocation rate by multiple risk factor combinations identified numerous cohorts with either an elevated risk or a diminished risk for dislocation. This multicenter study of 10,023 rTSA patients demonstrated that 1.4% of the patients experienced dislocation with one specific medialized glenoid–lateralized humerus onlay rTSA prosthesis. Stratifying patients by multiple combinations of risk factors demonstrated the impact of accumulating risk factors on the incidence of dislocation. rTSA patients with the greatest risk of dislocation were those of male sex, age ≤67 years at the time of surgery, patients with body mass index ≥31, patients who received cemented humeral stems, patients who received glenospheres having a diameter >40 mm, and/or patients who received expanded or laterally offset glenospheres. Patients with these risk factors who are considering rTSA using a medial glenoid–lateral humerus should be made aware of their elevated dislocation risk profile. [ABSTRACT FROM AUTHOR]

Systemic inflammation and oxidation are primary contributors to the development of atherosclerosis. Oxidation of low-density lipoprotein (LDL) particles within the vascular endothelium has been hypothesized to be an initial step in the formation of atherosclerotic plaques, with inflammatory cytokines serving as the signaling mechanism for concomitant macrophage activation. Supplementation with the antioxidative macular xanthophylls (lutein [L], zeaxanthin [Z], and meso-zeaxanthin [MZ]) has been shown to aid in the reduction of inflammatory physiologic responses; therefore, we hypothesized that in our study population, supplementation with these xanthophylls would facilitate a systemic reduction in markers of inflammation and cardiovascular lipid oxidation. In this double-blind placebo-controlled supplementation study, participants were randomly allocated to receive the active intervention containing L (10 mg) + MZ (10 mg) + Z (2 mg) or placebo (containing sunflower oil). Serum concentrations of carotenoids (assessed by HPLC), inflammatory cytokines (IL-6, IL-1β, TNF-α) and oxidized LDL (OxLDL; by solid-phase sandwich ELISA) were measured at baseline and at 6-months. Results showed that over the supplementation period, compared to placebo, the active group demonstrated statistically significant increases in serum concentrations of L, Z, & MZ (p < 0.05), reductions in inflammatory cytokines IL-1β (p < 0.001) and TNF-α (p = 0.003), as well as a corresponding reduction in serum OxLDL (p = 0.009). Our data show that L, Z, & MZ supplementation results in decreased serum IL-1β, TNF-α, and OxLDL. This suggests that these carotenoids are acting systemically to attenuate oxidative lipid products and inflammation, thus reducing their contribution to atherosclerotic plaque formation. [Display omitted] • Lutein, zeaxanthin, and meso-zeaxanthin (L, Z, & MZ) are dietary antioxidants. • L, Z, & MZ supplementation decreases pro-inflammatory cytokines IL-1β and TNF-α. • L, Z, & MZ supplementation decreases serum oxidized low density lipoprotein (LDL). • Systemic oxidation and inflammation contribute to vascular plaque formation. [ABSTRACT FROM AUTHOR]

Colorectal cancer is the most frequently diagnosed neoplasm in the population worldwide, regardless of sex. Its presentation is variable, from asymptomatic cases that are diagnosed in the population screening programme, to perforation or intestinal obstruction that appear urgently. The location of the neoplasia inside an inguinal hernia, although it is described in the literature, is uncommon and may increase the risk of incarceration or strangulation with the need for urgent surgery. We report a patient who presents adenocarcinoma of the sigmoid colon lodged in a giant inguino-scrotal hernia. [ABSTRACT FROM AUTHOR]

While surgeons attempt to correct the baseplate version of a reverse total shoulder arthroplasty (rTSA), clinical outcomes based on the planned final version remain unknown. The purpose of this study is to determine the clinical and radiographic outcomes of rTSA based on the planned final version of the baseplate. Our hypothesis is that increasing component retroversion will not affect outcomes. All primary rTSA patients in a multicentered international registry with a 2-year minimum follow-up implanted with computer navigation were included, except fracture and revision indications. A single medialized glenoid/lateralized humerus rTSA implant system was used with a standard or augmented baseplate. Patients were stratified by baseplate type and final planned baseplate version into 2 cohorts: 0°-5° (Group 1) or 6°-15° (Group 2) of retroversion. Demographics, radiographic outcomes, range of motion, and patient-reported outcome scores were compared between groups using Welch's t-test and Fisher's Exact test. Five hundred and thirty-five patients (307 females/226 males/2 unknown) were identified, with a mean follow-up of 30 months. Demographics were similar between the cohorts. The mean native and final retroversion was 9.0° and 1.5° in Group 1 and 16.3° and 8.6° in Group 2, respectively. Preoperatively, 72% of patients were 6°-15° retroverted. Postoperatively, 73% of patients were 0°-5° retroverted and 27% were 6°-15°, with 97% of patients having less than or equal to 10° of planned baseplate retroversion. Without stratifying for baseplate types, there were no clinically significant differences between the cohorts with regards to postoperative pain, range of motion, or patient-reported outcome scores, except for abduction and internal rotation greater in the 6°-15° and 0°-5° cohorts, respectively. Scapular notching was low (7% vs. 8%) and less than reported without computer navigation. Complication and revision rates were similar between the 2 groups. Patient satisfaction was high (much better/better, 94% vs 95%) and not significantly different between the 2 groups. There were no significant clinical differences between cohorts. This study demonstrates that favorable outcomes are achieved with a planned final baseplate version of less than 15° retroversion, with few differences between 0°-5° and 6°-15°. rTSA is forgiving enough such that one may plan to correct preoperative retroversion to less than 15° postoperatively in lieu of targeting postoperative version between 0°-5° for patients with higher native retroversion, potentially requiring less eccentric reaming especially when combined with other corrective measures. [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) and hemiarthroplasty are recognized treatment options for significantly displaced proximal humerus fractures. Repair of the tuberosities and preservation of rotator cuff function is a principle of treatment to enhance function and prevent instability. Humeral fracture stems were developed to improve tuberosity union with hemiarthroplasty, and similarly fracture stems are used with rTSA with promising results. However, there are conflicting studies on the use of fracture stems in improving outcomes in rTSA for proximal humerus fracture. The purpose of this study is to determine the clinical and radiographic outcomes, complication and revision rates, and patient satisfaction for fracture vs. standard stems for acute proximal humerus fracture treated with rTSA. A prospective multi-institutional institutional review board approved registry with a minimum two-year follow-up was queried and identified 231 patients that underwent rTSA for acute proximal humerus fracture, 187 of which received a fracture stem and 44 that received a standard stem. Patients were excluded if there was a previous fracture repair, malunion, or nonunion. Patient demographics, clinical and radiographic outcomes, complications, revision surgery, and patient reported outcome measures were collected preoperatively and at latest follow-up postoperatively. The mean follow-up was 48 ± 24 and 54 ± 34 months, mean age was 74 ± 7.9 and 72 ± 8.6 years, and mean body mass index was 28 ± 6.1 and 30 ± 5.3 kg/m2 for fracture and standard stems, respectively. Both fracture and standard stem groups showed significant improvements in patient reported clinical outcomes preoperative to postoperatively. Postoperatively, patients with fracture and standard stems had comparable abduction, forward elevation, internal rotation, external rotation, Visual Analog Scale pain, Global Shoulder Function scale, Simple Shoulder Test scale, American Shoulder and Elbow Surgeons scale, University of California Los Angeles Shoulder score, and Shoulder Arthroplasty Smart score. Patient satisfaction was high and did not differ between the two groups. Similar rates of humeral radiolucent lines, scapular notching, complications, and revision rates occurred between the fracture vs. standard stem groups. There were no significant differences in postoperative clinical outcomes, radiographic outcomes, complication rate, revision rate, and patient satisfaction between the fracture and standard stem groups for the treatment of acute proximal humerus fracture using rTSA. Both stems significantly improved clinical outcomes postoperatively. Either a fracture or standard stem may be used to achieve improved clinical outcomes for acute proximal humerus fracture using rTSA. [ABSTRACT FROM AUTHOR]

This study aimed to analyze how spatiotemporal gait parameters, active knee extension range of motion, muscle activity, and self-perceived function change over a seven-day period in healthy individuals after exercise-induced muscle damage (EIMD) in the hamstrings. Longitudinal cohort study. Twenty-four healthy males participated in four sessions before and after EIMD (pre-EIMD, 48 h, 96 h, and 168 h post-EIMD). A single-leg deadlift exercise was performed to provoke EIMD in the hamstrings of the dominant leg. Lower limb function perception, spatiotemporal gait parameters, active knee extension range of motion, and electromyographic (EMG) activity of the semitendinosus and biceps femoris muscles during gait and maximal isometric contraction were assessed bilaterally. At 48 h, the EIMD-side showed reduced step length, active knee extension range of motion, maximal strength and EMG activity compared to baseline (P < 0.042), while increased relative EMG activity in the biceps femoris during gait (P = 0.001). At 96 h, step length and EMG activity on the EIMD-side reached similar values to those at baseline, whereas lower limb function perception and active knee extension range of motion returned to baseline state at 168 h post-EIMD. No changes over time were observed on the control-side. Recovery from EIMD requires a multimodal assessment since the different parameters affected by EIMD recover at different paces. Active range of motion appears to be the last variable to fully recover. Self-perceived function should not be considered in isolation as it does not represent complete functional recovery. [ABSTRACT FROM AUTHOR]

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The Latarjet procedure transfers the coracoid process to the anterior glenoid. This prevents recurrent anterior humeral dislocation but alters the origins of the coracobrachialis (CBR) and short head of the biceps (SHB). The impact of this alteration on the moment arms of these muscles has not been examined. The Newcastle Shoulder Model was updated with 15 healthy cadaveric bone models to create customized shoulder models. The CBR and SHB muscles were attached to the anterior glenoid via an elliptical wrapping object. Muscle moment arms were calculated for abduction, forward flexion, scapular plane elevation, and internal rotation with 20° and 90° of abduction. Statistical comparison of moment arms between native and Latarjet shoulders was performed using spm1D. By transferring the origins of the CBR and SHB to the anterior glenoid, both muscles had extension moment arms during glenohumeral elevation in the coronal, sagittal, and scapular planes. Their average moment arms during abduction (−30.4 ± 3.2 mm for CBR and −29.8 ± 3.0 mm for SHB) and forward flexion (−26.0 ± 3.1 mm for CBR and −26.2 ± 3.2 mm for SHB) suggested that their role after the Latarjet procedure changed compared with their role in the native shoulder (P <.001). At higher abduction levels, both the muscles had higher internal rotation moment arms compared with the native shoulder. The Latarjet procedure affected the moment arms of the CBR and SHB. Both muscles had increased extension and internal rotation moment arms at higher degrees of elevation compared with the native shoulders. This finding suggests that these muscles act as dynamic stabilizers after the Latarjet procedure. [ABSTRACT FROM AUTHOR]

The patient concerns inventory (PCI) allows patients to highlight the issues they would like to discuss at their outpatient consultation. It improves patient-clinician communication and has proven benefits. While the PCI is effective, patient experiences could be improved with better access to it and the ability to more easily and frequently express their concerns. This, of course, is in the context of ever-increasing healthcare challenges and limited resources. Use of conversational artificial intelligence (CAI) represents an opportunity to improve information flow between patients and professionals remote from the consultation. This paper highlights the potential for CAI to provide an 'always-on' platform, using natural language interface technology and based on the PCI, which patients can access via their mobile devices. We also discuss potential pitfalls and concerns, along with outlining a current clinical trial assessing, in the first instance, usability of this technology. [ABSTRACT FROM AUTHOR]

Machine learning (ML)–based clinical decision support tools (CDSTs) make personalized predictions for different treatments; by comparing predictions of multiple treatments, these tools can be used to optimize decision making for a particular patient. However, CDST prediction accuracy varies for different patients and also for different treatment options. If these differences are sufficiently large and consistent for a particular subcohort of patients, then that bias may result in those patients not receiving a particular treatment. Such level of bias would deem the CDST "unfair." The purpose of this study is to evaluate the "fairness" of ML CDST-based clinical outcomes predictions after anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA) for patients of different demographic attributes. Clinical data from 8280 shoulder arthroplasty patients with 19,249 postoperative visits was used to evaluate the prediction fairness and accuracy associated with the following patient demographic attributes: ethnicity, sex, and age at the time of surgery. Performance of clinical outcome and range of motion regression predictions were quantified by the mean absolute error (MAE) and performance of minimal clinically important difference (MCID) and substantial clinical benefit classification predictions were quantified by accuracy, sensitivity, and the F1 score. Fairness of classification predictions leveraged the "four-fifths" legal guideline from the US Equal Employment Opportunity Commission and fairness of regression predictions leveraged established MCID thresholds associated with each outcome measure. For both aTSA and rTSA clinical outcome predictions, only minor differences in MAE were observed between patients of different ethnicity, sex, and age. Evaluation of prediction fairness demonstrated that 0 of 486 MCID (0%) and only 3 of 486 substantial clinical benefit (0.6%) classification predictions were outside the 20% fairness boundary and only 14 of 972 (1.4%) regression predictions were outside of the MCID fairness boundary. Hispanic and Black patients were more likely to have ML predictions out of fairness tolerance for aTSA and rTSA. Additionally, patients <60 years old were more likely to have ML predictions out of fairness tolerance for rTSA. No disparate predictions were identified for sex and no disparate regression predictions were observed for forward elevation, internal rotation score, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, or global shoulder function. The ML algorithms analyzed in this study accurately predict clinical outcomes after aTSA and rTSA for patients of different ethnicity, sex, and age, where only 1.4% of regression predictions and only 0.3% of classification predictions were out of fairness tolerance using the proposed fairness evaluation method and acceptance criteria. Future work is required to externally validate these ML algorithms to ensure they are equally accurate for all legally protected patient groups. [ABSTRACT FROM AUTHOR]

The field of durable mechanical circulatory support (MCS) has undergone an incredible evolution over the past few decades, resulting in significant improvements in longevity and quality of life for patients with advanced heart failure. Despite these successes, substantial opportunities for further improvements remain, including in pump design and ancillary technology, perioperative and postoperative management, and the overall patient experience. Ideally, durable MCS devices would be fully implantable, automatically controlled, and minimize the need for anticoagulation. Reliable and long-term total artificial hearts for biventricular support would be available; and surgical, perioperative, and postoperative management would be informed by the individual patient phenotype along with computational simulations. In this review, we summarize emerging technological innovations in these areas, focusing primarily on innovations in late preclinical or early clinical phases of study. We highlight important considerations that the MCS community of clinicians, engineers, industry partners, and venture capital investors should consider to sustain the evolution of the field. [Display omitted] [ABSTRACT FROM AUTHOR]

Severe glenoid deformity has been associated with inferior outcomes and higher complication rates in shoulder arthroplasty. In patients with intact rotator cuffs, there is no clear consensus as to whether anatomic total shoulder arthroplasty (aTSA) or reverse (rTSA) shoulder arthroplasty is the optimal implant in patients with glenoid deformities. The purpose of this study was to compare outcomes of aTSA vs. rTSA in glenoid deformities with greater than 15° retroversion. A retrospective review of a large multicenter database was conducted. All patients who underwent either aTSA or rTSA with an intact rotator cuff and glenoid retroversion 15° or greater with minimum 2-year follow-up were included. Range of motion (ROM), revisions, and patient reported outcomes (PROs) including Constant score, Simple Shoulder test, American Shoulder and Elbow Surgeons score, University of California Los Angeles shoulder score, Shoulder Pain and Disability Index), Shoulder Arthroplasty Smart score were collected for all patients pre and postsurgery. Overall, 336 patients were included with 187 receiving an aTSA and 149 rTSA. Reverse patients overall had more comorbidities (75.0% vs. 65.1%; P =.05) and were older (70.9 ± 7.0 vs. 66.3 ± 7.7 years; P <.001). Average follow-up for the aTSA group was 62.0 ± 37.8 months vs. 40.6 ± 22.9 months for rTSA (P <.001). Preoperative retroversion in the anatomic group averaged 20.7 ± 5.5 degrees vs. 24.2 ± 7.7 in reverse patients (P <.001). Both groups demonstrated significant improvements in all PROs and ROM from pre to postsurgery. At latest follow-up aTSA patients had significantly better internal rotation scores (4.9 ± 1.6 vs. 4 ± 1.8; P <.001), external rotation (50 ± 19 vs. 38 ± 18; P <.001) and Shoulder Arthroplasty Smart scores (80.2 ± 13.5 vs. 76.6 ± 11.3; P =.017) but worse pain VAS (1.5 ± 2.3 vs. 0.9 ± 1.9; P =.016). There was no significant difference in abduction or forward elevation or PRO's (Shoulder function, Simple Shoulder test, Constant, American Shoulder and Elbow Surgeons score, University of California Los Angeles shoulder score, or Shoulder Pain and Disability Index). Overall revision rate (7% vs. 1%; P =.002) was higher in aTSA. ATSA and rTSA results in significant improvements in patients with glenoid retroversion equal or greater than 15°. Anatomic TSA patients have better postoperative internal rotation score, external rotation, and SAS score but demonstrated no other significant improvement in ROM or PRO. However, there was significantly higher rate of complications and revisions with short-term follow-up following aTSA. [ABSTRACT FROM AUTHOR]

Rising rates of cardiometabolic risk and mental health problems are serious public health concerns for US adolescents, particularly those of Latinx origin. This research examines how Latinx youth's internalizing symptoms during early adolescence are related to sleep problems, overweight/obesity, sedentary behavior, physical activity, healthy diet, and hypertension or diabetes risk during middle and late adolescence. Participants included 547 adolescents listed as "Hispanic" on 2017-18 middle school enrollment lists in a suburban Atlanta, GA school district. Survey data collected at baseline (2018) and four years later (2022) were analyzed using Structural Equation Model. Path estimates from baseline internalizing symptoms to later health behaviors and physical health outcomes adjusted for demographics, the follow-up measure of internalizing symptoms, and correlations among outcome variables. Missing data were handled using Full Information Maximum Likelihood. At baseline, the 244 (44.6%) male and 303 (55.4%) female participants had a mean (standard deviation) age in years of 13.31 (0.97). Early adolescent internalizing symptoms were associated positively with later sleep problems (ß = 0.36 [95% confidence interval (CI), 0.24–0.48]), overweight/obesity (adjusted odds ratio, 2.57; 95% CI, 1.29–5.15), sedentary behavior (ß = 0.19 [95% CI, 0.09–0.30]), and internalizing symptoms (ß = 0.48 [95% CI, 0.39–0.56]) and inversely with later physical activity (ß = −0.16 [95% CI, −0.27 to −0.05]) and a healthy diet (ß = −0.21 [95% CI, −0.32 to −0.09]). Latinx youth's internalizing symptoms during early adolescence not only track into later adolescence, but they also relate to health behaviors and outcomes underlying cardiometabolic risk during middle and late adolescence. [ABSTRACT FROM AUTHOR]

• For patients with coronary artery disease, the two most common options for intervention are a vascular stent or a coronary artery bypass graft. • Although less invasive, vascular stents may pose a long-term risk for patients undergoing further invasive procedures such as elective spine surgery. • This study aimed to provide surgeons with insight on possible major complications for elective spine surgery patients with a history of CAD. • When assessing patients with a history of coronary artery disease for elective spine fusion surgery, surgeons should be cautious of the significant risk of major complications associated with vascular stents. Revascularization is a more effective intervention to reduce future postop complications. Patients undergoing elective spine fusion surgery were isolated in the PearlDiver database. Patients were stratified by having previous history of vascular stenting (Stent), coronary artery bypass graft (CABG), and no previous heart procedure (No-HP). Means comparison tests (chi-squared and independent samples t-tests, as appropriate) compared differences in demographics, diagnoses, and comorbidities. Binary logistic regression assessed the odds of 30-day and 90-day postoperative (postop) complications associated with each heart procedure (Odds Ratio [95 % confidence interval]). Statistical significance was set p < 0.05. 731,173 elective spine fusion patients included. Overall, 8,401 pts underwent a CABG, 24,037 pts Stent, and 698,735 had No-HP prior to spine fusion surgery. Compared to Stent and No-HP patients, CABG patients had higher rates of morbid obesity, chronic kidney disease, and diabetes (p < 0.001 for all). Meanwhile, stent patients had higher rates of PVD, hypertension, and hyperlipidemia (all p < 0.001). 30-days post-op, CABG patients had significantly higher complication rates including pneumonia, CVA, MI, sepsis, and death compared to No-HP (all p < 0.001). Stent patients vs. No-HF had higher 30-day post-op complication rates including pneumonia, CVA, MI, sepsis, and death. Furthermore, adjusting for age, comorbidities, and sex Stent was significantly predictive of a MI 30-days post-op (OR: 1.90 [1.53–2.34], P < 0.001). Additionally, controlling for levels fused, stent patients compared to CABG patients had 1.99x greater odds of a MI within 30-days (OR: 1.99 [1.26–3.31], p = 0.005) and 2.02x odds within 90-days postop (OR: 2.2 [1.53–2.71, p < 0.001). With regards to spine surgery, coronary artery bypass graft remains the gold standard for risk reduction. Stenting does not appear to minimize risk of experiencing a post-procedure cardiac event as dramatically as CABG. [ABSTRACT FROM AUTHOR]

The Walch classification is commonly used by surgeons when determining the treatment of osteoarthritis (OA). However, its utility in prognosticating patient clinical state before and after TSA remains unproven. We assessed the prognostic value of the modified Walch glenoid classification on preoperative clinical state and postoperative clinical and radiographic outcomes in total shoulder arthroplasty (TSA). A prospectively collected, multicenter database for a single-platform TSA system was queried for patients with rotator cuff–intact OA and minimum 2 year follow-up after anatomic (aTSA) and reverse TSA (rTSA). Differences in patient-reported outcome scores (Simple Shoulder Test, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Shoulder Pain and Disability Index, visual analog scale for pain, Shoulder Function score), combined patient-reported and clinical-input scores (Constant, University of California–Los Angeles shoulder score, Shoulder Arthroplasty Smart Score), active range of motion values (forward elevation [FE], abduction, external rotation [ER], internal rotation [IR], and radiographic outcomes (humeral and glenoid radiolucency line rates, scapula notching rate) were stratified and compared by glenoid deformity type per the Walch classification for aTSA and rTSA cohorts. Comparisons were performed to assess the ability of the Walch classification to predict the preoperative, postoperative, and improved state after TSA. 1008 TSAs were analyzed including 576 aTSA and 432 rTSA. Comparison of outcomes between Walch glenoid types resulted in 15 pairwise comparisons of 12 clinical outcome metrics, yielding 180 total Walch glenoid pairwise comparisons for each clinical state (preoperative, postoperative, improvement). Of the 180 possible pairwise Walch glenoid type and metric comparisons studied for aTSA and rTSA cohorts, <6% and <2% significantly differed in aTSA and rTSA cohorts, respectively. Significant differences based on Walch type were seen after adjustment for multiple pairwise comparisons in the aTSA cohort for FE and ER preoperatively, the Constant score postoperatively, and for abduction, FE, ER, Constant score, and SAS score for pre- to postoperative improvement. In the rTSA cohort, significant differences were only seen in abduction and Constant score both postoperatively and for pre- to postoperative improvement. There were no statistically significant differences in humeral lucency rate, glenoid lucency rate (aTSA), scapular notching rate (rTSA), complication rates, or revision rates between Walch glenoid types after TSA. Although useful for describing degenerative changes to the glenohumeral joint, we demonstrate a weak association between preoperative glenoid morphology according to the Walch classification and clinical state when evaluating patients undergoing TSA for rotator cuff–intact OA. Alternative glenoid classification systems or predictive models should be considered to provide more precise prognoses for patients undergoing TSA for rotator cuff–intact OA. [ABSTRACT FROM AUTHOR]

• It is unclear if nonpharmacological interventions for persons with dementia (PwD) is tested among a diverse sample of individuals. • Sample characteristics, including gender, race, and ethnicity, were not consistently reported across studies. • Black and Hispanic/Latino participants were underrepresented in the included studies of this systematic literature review. • Studies implementing nonpharmacological interventions for PwD need to be intentional about enhancing sample diversity. Background: A public health priority is the increasing number of people with dementia (PwD), and nonpharmacological interventions (NPIs) might offer support. We sought to synthesize types of NPIs tested among PwD and explore sample characteristics. Methods: This study was a scoping literature review. Eligible articles were identified using the search terms "nonpharmacological intervention" and "dementia". Results: 36 articles were included. Psychosocial NPIs were implemented the most (n=24) and music-based interventions were found to be the most effective. Gender, race, and ethnicity were not consistently reported (n=30, n=24, and n=6, respectively). White PwD had higher representation, with only 62.5% of studies including Black participants and 25% including Hispanic/Latino participants. Women made up a majority (>50%) of the sample in a greater number of studies (n=20). Conclusion: Findings suggest that future studies need to be intentional about improving diversity of the sample, particularly with respect to including persons identifying as Black or Hispanic/Latino. [ABSTRACT FROM AUTHOR]

We aimed to determine the prevalence and risk factors for dysphagia in adults 65 years and older before and after thyroidectomy or parathyroidectomy. We performed a longitudinal prospective cohort study of older adults undergoing initial thyroidectomy or parathyroidectomy. We administered the Dysphagia Handicap Index questionnaire preoperatively and 1, 3, and 6 months postoperatively. We compared preoperative and postoperative total and domain-specific scores using paired t tests and identified risk factors for worse postoperative scores using multivariable logistic regression. Of the 175 patients evaluated, the mean age was 71.1 years (range = 65–94), 73.7% were female, 40.6% underwent thyroidectomy, 57% underwent bilateral procedures, and 21.1% had malignant diagnoses. Preoperative swallowing dysfunction was reported by 77.7%, with the prevalence 22.4% greater in frail than robust patients (P =.013). Compared to preoperative scores, 43.4% and 49.1% had worse scores at 3 and 6 months postoperatively. Mean functional domain scores increased by 62.3% at 3 months postoperatively (P =.007). Preoperative swallowing dysfunction was associated with a 3.07-fold increased likelihood of worse functional scores at 3 months. Whereas frailty was associated with preoperative dysphagia, there was no association between worse postoperative score and age, sex, race, frailty, body mass index, smoking status, gastroesophageal reflux disease, comorbidity index, malignancy, surgical extent, or type of surgery. Adults 65 years and older commonly report swallowing impairment preoperatively, which is associated with a 3.07-fold increased likelihood of worsened dysphagia after thyroid and parathyroid surgery that may persist up to 6 months postoperatively. [ABSTRACT FROM AUTHOR]

The foreign body response (FBR) to implanted materials culminates in the deposition of a hypo-permeable, collagen rich fibrotic capsule by myofibroblast cells at the implant site. The fibrotic capsule can be deleterious to the function of some medical implants as it can isolate the implant from the host environment. Modulation of fibrotic capsule formation has been achieved using intermittent actuation of drug delivery implants, however the mechanisms underlying this response are not well understood. Here, we use analytical, computational, and in vitro models to understand the response of human myofibroblasts (WPMY-1 stromal cell line) to intermittent actuation using soft robotics and investigate how actuation can alter the secretion of collagen and pro/anti-inflammatory cytokines by these cells. Our findings suggest that there is a mechanical loading threshold that can modulate the fibrotic behaviour of myofibroblasts, by reducing the secretion of soluble collagen, transforming growth factor beta-1 and interleukin 1-beta, and upregulating the anti-inflammatory interleukin-10. By improving our understanding of how cells involved in the FBR respond to mechanical actuation, we can harness this technology to improve functional outcomes for a wide range of implanted medical device applications including drug delivery and cell encapsulation platforms. A major barrier to the successful clinical translation of many implantable medical devices is the foreign body response (FBR) and resultant deposition of a hypo-permeable fibrotic capsule (FC) around the implant. Perturbation of the implant site using intermittent actuation (IA) of soft-robotic implants has previously been shown to modulate the FBR and reduce FC thickness. However, the mechanisms of action underlying this response were largely unknown. Here, we investigate how IA can alter the activity of myofibroblast cells, and ultimately suggest that there is a mechanical loading threshold within which their fibrotic behaviour can be modulated. These findings can be harnessed to improve functional outcomes for a wide range of medical implants, particularly drug delivery and cell encapsulation devices. [Display omitted] [ABSTRACT FROM AUTHOR]

The purpose of this investigation was to compare minimum two-year outcomes of anatomic total shoulder arthroplasty (aTSA) performed with humeral head resurfacing (HHR) vs. stemless implants. A retrospective review of a large multicenter database was conducted. All patients who underwent aTSA with either HHR or stemless implants with minimum two-year follow-up were evaluated. Range of motion (ROM) and patient-reported outcomes (PROs) including Constant Score, Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons score, University of California Los Angeles Shoulder Score, Shoulder Pain and Disability Index, and Shoulder Arthroplasty Smart score were collected for all patients presurgery and postsurgery. Radiographic data was collected to determine the presence of radiolucent lines as well as evaluate implant sizing and anatomic shoulder restoration. Overall, 127 patients were included with 49 patients receiving HHR and 78 stemless aTSA. Preoperatively, patients in the HHR group had worse ROM and PRO scores (P <.05). Although the stemless group had significantly greater active abduction (148 ± 28 vs. 116 ± 22, P <.001), forward flexion (154 ± 21 vs. 141 ± 15, P <.001) and external rotation (50 ± 16 vs. 34 ± 17, P <.001) and exhibited better scores on the SST (10.4 ± 2.0 vs. 9.5 ± 1.9, P =.014) at final postoperative evaluation, the HHR group had a greater improvement from preoperative to final postoperative evaluation in active forward flexion (50 ± 22 vs. 32 ± 20, P <.001) and internal rotation (3 ± 2 vs. 1 ± 2, P =.004) as well as all PROs measured (P <.01). Both groups demonstrated significant improvements in all PROs and ROM from presurgery to postsurgery (P <.05). Rates of overstuffing (8.7% in HHR vs. 20.8% stemless, P =.098), oversizing (39.1% in HHR vs. 31.3% in stemless, P =.436), and radiolucent lines around the glenoid components (13.0% in HHR vs. 18.8% in stemless, P =.450) were not significantly different between the groups. One patient in the stemless group required a revision surgery for aseptic glenoid loosening, otherwise no other major complications were reported. aTSA performed both with stemless implants and HHR resulted in significant improvements in ROM and multiple PROs at minimum two-year follow-up with a low complication rate. The HHR group had worse preoperative shoulder function, which contributed to a greater magnitude of improvement in ROM and across all PROs from presurgery to postsurgery, despite the stemless group having better ROM and SST scores at final follow-up. [ABSTRACT FROM AUTHOR]

This study compared the Salzmann Index (SI) to the American Association of Orthodontists–proposed Automatic Qualifying Conditions (AQC) list in determining eligibility for medically necessary orthodontic care (MNOC). In Pennsylvania, The SI must reflect a score of ≥25, whereas the AQCs are considered binary indicators of a treatment need—the presence of any AQC qualifies a patient for treatment under Medicaid. This study was designed to determine whether the same patients are selected as eligible for MNOC regardless of which selection method is used. The orthodontic records of 139 participants aged 10-17 years were used to calculate SI scores and identify any AQCs present. McNemar's test of agreement was used to compare patients selected for treatment needs on the basis of SI to those selected on the basis of the presence of an AQC. The mean SI score was 14.7. Twelve patients (8.6%) were selected for treatment needs because of an SI of ≥25, whereas 44 patients (31.7%) were deemed to have at least 1 AQC present. Of the 44 patients with AQCs, only 11 had SI scores of ≥25. McNemar's test of agreement found that SI score and AQC presence did not select patients similarly (P <0.001). The SI and AQCs do not appear to select the same patients for MNOC, suggesting that replacing the SI with a list of AQCs would significantly impact which patients are selected for Medicaid-funded orthodontic care in Pennsylvania. • The Salzmann Index has been used to determine the medical need for orthodontics. • Automatic Qualifying Condition lists are now being used for ease of use. • This study aimed to compare which patients were selected using each method. • These 2 methods selected different patients as medically requiring treatment. [ABSTRACT FROM AUTHOR]

Tendons play a crucial role allowing the storage and release of mechanical energy during the running cycle. Running kinematics, including duty factor, constitute a basic element of the runner's biomechanics, and can determine their performance. This study aimed to analyze the link between Achilles tendon and plantar fascia morphology and running parameters, considering the influence of wearing shoes versus running barefoot. Cross-sectional study. 44 participants (30 men and 14 women) engaged in two running sessions, one with shoes and one without, both lasting 3 min at a consistent speed of 12 km/h. We captured running kinematic data using a photoelectric cell system throughout the sessions. Before the trials, we measured the thickness and cross-sectional area of both the Achilles tendon and plantar fascia using ultrasound. The Pearson test revealed a significant correlation (p < 0,05) between Achilles tendon and plantar fascia morphology and contact time (r > − 0.325), flight time (r > − 0.325) and duty factor (ratio of ground contact to stride time) (r > − 0.328) during barefoot running. During the shod condition, no significant correlation was found between connective tissue morphology and kinematic variables. In barefoot running, greater size of the Achilles tendon and plantar fascia results in a reduced duty factor, attributed to longer flight times and shorter contact times. [ABSTRACT FROM AUTHOR]

Walch type B2 glenoids are frequent (about 40% of primary osteoarthritis) and complex to manage. Nonetheless, the origin of this deformity remains elusive to this day. The rotator cuff muscle volume, more particularly the transverse force couple (TFC = Infraspinatus (IS) + Teres minor (Tm) + Subscapularis (SS)) could, play a role in the origin of Walch type B2 deformity. The objective of this study was to analyze the TFC in patients with Walch B2 compared with Walch A2 shoulder osteoarthritis. We hypothesize there is a TFC imbalance in favor of the external rotators in Walch B2 shoulder osteoarthritis. 120 computed tomography scans were analyzed, 65 scans with Walch B2 and 55 scans with Walch A2 shoulder osteoarthritis. On each study, the volume analysis of the SS, IS, and Tm was assessed by two surgeons. The ratio of SS volume/(IS volume + Tm volume) was compared in patients with Walch B2 and A2 shoulder osteoarthritis. The ratio of SS volume/(IS volume + Tm volume) was significantly lower (P <.0001) in Walch B2 glenoid (0.99) than in Walch A2 glenoid (1.24). The volume of the posterior group (IS and Tm) was significantly greater in the B2 glenoid 103.1 (76.7-134.5) cm3 than in the A2 glenoid 86.2 (68.00-105.25) cm3 (P =.026). Regarding SS volume, there was no significant difference between B2 glenoid 103.7 cm3 (73.3-146.2) and A2 glenoid 101.3 cm3 (83.0-135.9) P =.885. There is no imbalance of TFC in Walch B2 glenoid. However, the TFC ratio is lower in Walch B2 glenoid compared to Walch A2 glenoid. This is related to a significantly greater volume of the external rotators in the Walch B2 patients. [ABSTRACT FROM AUTHOR]

• As our focus on delivering cost effective healthcare increases, interventions like cervical deformity surgery, which are associated with high resource utilization, have received greater scrutiny. • High cost surgical patients had higher odds of reaching minimum clinical important difference with lower rates of reoperation with better alignment postoperatively. • Despite continued scrutiny over healthcare costs, we found that more costly surgical interventions can produce superior radiographic alignment as well as patient reported outcomes for patients with cervical deformity. As our focus on delivering cost effective healthcare increases, interventions like cervical deformity surgery, which are associated with high resource utilization, have received greater scrutiny. The purpose of this study was to assess relationship between surgical costs, deformity correction, and patient reported outcomes in ACD surgery. ACD Patients ≥ 18 years with baseline (BL) and 2-year (2Y) data were included. Cost of surgery was calculated by applying average Medicare reimbursement rates by CPT code to surgical details of each patient in the cohort. CPT codes for corpectomy, ACDF, osteotomy, decompression, levels fused, and instrumentation were considered in the analysis. Costs of complications and reoperations were intentionally excluded from the cost analysis. Patients were ranked into two groups by surgical cost: lowest cost (LC) and highest cost (HC). ANCOVA assessed differences in outcomes while accounting for covariates as appropriate. 113 met inclusion criteria. While mean age, frailty, BMI and gender composition were similar between cost groups, mean CCI was significantly higher in the HC group compared to that of the LC group (p=.014). At baseline, LC and HC groups had similar HRQLs and radiographic deformity (all p >.05). Logistic regression accounting for baseline age, deformity and CCI found that HC patients had significantly lower odds of undergoing reoperation within 2-years (OR: 0.309, 95 % CI: 0.193 - 0.493, p <.001). Furthermore, logistic regression accounting for baseline age, deformity and CCI found odds of DJF were significantly lower for those in the HC group (OR: 0.163, 95 % CI: 0.083 - 0.323, p <.001). At 2-years, logistic regression accounting for age and baseline TS-CL found HC patients still had significantly higher odds of reaching a "0″ TS-CL modifier at 2-years (OR: 3.353, 95 % CI: 1.081 – 10.402, p=.036). Logistic regression accounting for age and baseline NDI score found HC patients had significantly higher odds of reaching MCID in NDI at 2-years (OR: 4.477, 95 % CI: 1.507 – 13.297, p=.007). A similar logistic regression accounting for age and baseline mJOA score found odds of reaching MCID in mJOA significantly higher for high-cost patients (OR: 2.942, 95 % CI: 1.101 – 7.864, p=.031). While patient presentation influences surgical planning and costs, this study attempted to control for such variations to assess impact of surgical costs on outcomes. Despite continued scrutiny over healthcare costs, we found that more costly surgical interventions can produce superior radiographic alignment as well as patient reported outcomes for patients with cervical deformity. [ABSTRACT FROM AUTHOR]

Reverse total shoulder arthroplasty (RTSA) alters the line of action of muscles around the glenohumeral joint. The effects of these changes have been well characterized for the deltoid, but there is limited information regarding the biomechanical changes to the coracobrachialis (CBR) and short head of biceps (SHB). In this biomechanical study, we investigated the changes to the moment arms of the CBR and SHB due to RTSA using a computational model of the shoulder. The Newcastle Shoulder Model, a pre-validated upper-extremity musculoskeletal model, was used for this study. The Newcastle Shoulder Model was modified with bone geometries obtained from 3-dimensional reconstructions of 15 nondiseased shoulders, constituting the native shoulder group. The Delta XTEND prosthesis, with a glenosphere diameter of 38 mm and polyethylene thickness of 6 mm, was virtually implanted in all the models, creating the RTSA group. Moment arms were measured using the tendon excursion method, and muscle length was calculated as the distance between the muscle's origin and insertion points. These values were measured during 0°-150° of abduction, forward flexion, scapular-plane elevation, and –90° to 60° of external rotation–internal rotation with the arm at 20° and 90° of abduction. Statistical comparisons between the native and RTSA groups were analyzed using 1-dimensional statistical parametric mapping (spm1D). Forward flexion moment arms showed the greatest increase between the RTSA group (CBR, 25.3 ± 4.7 mm; SHB, 24.7 ± 4.5 mm) and native group (CBR, 9.6 ± 5.2 mm; SHB, 10.2 ± 5.2 mm). The CBR and SHB were longer in the RTSA group by maximum values of 15% and 7%, respectively. Both muscles had larger abduction moment arms in the RTSA group (CBR, 20.9 ± 4.3 mm; SHB, 21.9 ± 4.3 mm) compared with the native group (CBR, 19.6 ± 6.6 mm; SHB, 20.0 ± 5.7 mm). Abduction moment arms occurred at lower abduction angles in the RTSA group (CBR, 50°; SHB, 45°) than in the native group (CBR, 90°; SHB, 85°). In the RTSA group, both muscles had elevation moment arms until 25° of scapular-plane elevation motion, whereas in the native group, the muscles only had depression moment arms. Both muscles had small rotational moment arms that were significantly different between RTSA and native shoulders during different ranges of motion. Significant increases in elevation moment arms for the CBR and SHB were observed in RTSA shoulders; these increases were most pronounced during abduction and forward elevation motions. RTSA also increased the lengths of these muscles. [ABSTRACT FROM AUTHOR]

Identifying risk factors for acromial and scapular fractures improves our understanding about which variables are relevant to these fracture complications; however, these data are difficult to integrate into clinical practice because the majority of reverse total shoulder arthroplasty (rTSA) patients have ≥1 risk factor. The goal of this study was to better facilitate preoperative identification of patients at risk of acromial and scapular fractures and quantify the impact of accumulating risk factors on the incidence of fracture. We retrospectively analyzed 9079 rTSA patients from a multicenter database of rTSA procedures performed with a single medialized glenoid–lateralized humerus onlay rTSA prosthesis to quantify the rate of acromial and scapular fractures. Univariate and multivariate analyses were performed to identify risk factors for fracture. Next, we quantified the number of patients with 1 or multiple significant risk factors for fracture. Finally, to facilitate preoperative identification of patients most at risk of fracture, we stratified our data set using multiple combinations of age, sex, and diagnosis risk factors and calculated the odds ratio for each cohort to quantify the impact of accumulating risk factors on the incidence of fracture. A fracture of the acromion or scapula was radiographically identified in 138 of 9079 patients, for a rate of 1.52%. Patients with fractures were more likely to be older, of female sex, to have a diagnosis of rheumatoid arthritis and/or cuff tear arthropathy, and were less likely to have a diagnosis of diabetes. Eighty-five percent of rTSA patients had ≥1 fracture risk factor. Individually, age, sex, or diagnosis failed to identify any patient cohort with an odds ratio >2.5. Use of multiple combinations of patient risk factors refined the identification of at-risk patients better than any individual risk factor or 2–risk factor combination and demonstrated that the patients with the greatest fracture risk were female patients with a rheumatoid arthritis diagnosis who were aged >70, >75, and >80 years. This 9079-rTSA multicenter study demonstrated that 1.52% of patients experienced acromial and/or scapular fractures with a single medialized glenoid–lateralized humerus onlay rTSA prosthesis. Our analysis identified numerous risk factors and quantified the impact of accumulating risk factors on fracture incidence. Patients who are considering rTSA and who have these age, sex, and diagnosis risk factors should be made aware of their elevated complication risk. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has significantly impacted the mental well-being of health care workers (HCWs). This study assessed the feasibility, acceptability, and preliminary efficacy of two psychological interventions, gratitude journaling or cognitive strategies, on pediatric HCWs. A pilot randomized parallel repeated measures design was used, with a convenience sample of 59 HCWs. Data were collected before and after the intervention period, 2 weeks after, and again 6 months later. Outcomes included depression, anxiety, meaning and purpose, feasibility, and acceptability. Thirty-seven participants completed the study. The majority were nurses (registered nurses and advanced practice registered nurses) and physicians. In both groups, depression and anxiety scores diminished, but changes were not statistically significant. The study was feasible to conduct, and subjects reported high acceptability. Gratitude journaling and cognitive strategies may help mental well-being in HCWs; however, future studies with larger samples are needed. [ABSTRACT FROM AUTHOR]

Medial varus proximal tibial (MPT) resection or soft tissue releases (STRs) of the medial collateral ligament (MCL) in the form of pie-crusting can be performed to achieve a balanced knee in a varus deformity. Studies comparing the 2 modalities have not been addressed within the literature. Therefore, the aims of this study were to assess the following: (1) compartmental changes between the 2 methods and (2) changes in patient-reported outcome measurements. Using our institution's total joint arthroplasty registry, patients who underwent primary total knee arthroplasty from January 1, 2017, to December 31, 2019, were identified. The MPT resection and STR patients were 1:1 matched with baseline parameters yielding 196 patients. Outcomes of interest included: changes in compartmental pressures at 10, 45, and 90° degrees and change to the Short-Form 12, Western Ontario and McMaster Universities Osteoarthritis Index, and Forgotten Joint Scores (FJSs) at the 2-year follow-up period. A P value less than.05 was used as our threshold for statistical difference. The MPT resection led to significant reductions in compartmental pressures at 10° [43 versus 19 pounds (lbs.), P <.0001], 45° (43 versus 27 lbs., P <.0001), and 90° degrees (27 versus 16 lbs., P <.0001) compared to STR. MPT resection also had significantly improved Short-Form 12 (47 versus 38, P <.0001), Western Ontario and McMaster Universities Osteoarthritis Index (9 versus 21, P <.0001), and Forgotten Joint Score (79 versus 68, P =.005). Bone modification was superior to pie-crusting of the MCL in achieving consistent pressure balancing and improved outcomes. The investigation can guide surgeons on the preferred method to achieve a well-balanced knee. [ABSTRACT FROM AUTHOR]

Extensive proximal humeral bone loss in the setting of shoulder arthroplasty represents a difficult challenge for the treating surgeon. Achieving adequate fixation with standard humeral prostheses can be problematic. Allograft-prosthetic composites are a viable solution for this problem; however, high rates of complications have been reported. Modular proximal humeral replacement systems are another potential solution, but there is a paucity of outcome data on these implants. This study reports the 2-year minimum follow-up outcomes and complications of a single system reverse proximal humeral reconstruction prosthesis (RHRP) for patients with extensive proximal humeral bone loss. We retrospectively reviewed all patients with minimum 2-year follow-up who underwent implantation of an RHRP for either (1) failed shoulder arthroplasty or (2) proximal humerus fracture with severe bone loss (Pharos 2 and 3) and/or sequelae thereof. Forty-four patients met inclusion criteria (average age 68.3 ± 13.1 years). The average follow-up was 36.2 ± 12.4 months. Demographic information, operative data, and complications were recorded. Pre- and postoperative range of motion (ROM), pain, and outcome scores were assessed and compared to the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for primary rTSA where available. Of the 44 RHRPs evaluated, 93% (n = 39) had undergone prior surgery and 70% (n = 30) were performed for failed arthroplasty. ROM improved significantly in abduction by 22° (P =.006) and forward elevation by 28° (P =.003). Average pain on a daily basis and pain at worst improved significantly, by 2.0 points (P <.001) and 2.7 points (P <.001), respectively. Mean Simple Shoulder Test score improved by 3.2 (P <.001), Constant score by 10.9 (P =.030), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score by 29.7 (P <.001), University of California, Los Angeles (UCLA), score by 10.6 (P <.001), and Shoulder Pain and Disability Index score by 37.4 (P <.001). A majority of patients achieved the MCID for all outcome measures assessed (56%-81%). The SCB was exceeded by half of patients for forward elevation and the Constant score (50%), and exceeded by the majority of patients for the ASES score (58%) and UCLA score (58%). The complication rate was 28%; the most common complication was dislocation requiring closed reduction. Notably, there were no occurrences of humeral loosening requiring revision surgery. These data demonstrate that the RHRP resulted in significant improvements in ROM, pain, and patient-reported outcome measures, without the risk of early humeral component loosening. RHRP represents another potential solution for shoulder arthroplasty surgeons when addressing extensive proximal humerus bone loss. [ABSTRACT FROM AUTHOR]

The French Society of Digestive Surgery (Société Française de Chirurgie Digestive [SFCD]) has elaborated clinical practice guidelines for the management of the obese patient undergoing gastro-intestinal surgery. The literature was analyzed according to the GRADE® (Grading of Recommendations Assessment, Development and Evaluation) methodology divided into five chapters: preoperative management, modalities of transportation and installation of the patient in the operating room, specific characteristics related to laparoscopic surgery, specific characteristics related to traditional surgery, and postoperative management. Each question was formulated according to the PICO format (Patients, Intervention, Comparison, Outcome). Synthesis of expert opinions and the application of the GRADE methodology produced 30 recommendations among which three were strong and nine were weak. The GRADE methodology could not be applied for 18 questions, for which only expert opinion was obtained. These clinical practice guidelines can help surgeons optimize the peri-operative management of the obese patient undergoing gastro-intestinal surgery. [ABSTRACT FROM AUTHOR]

Perioperative intra-articular joint injection is a known risk factor for developing prosthetic joint infection (PJI) in the immediate preoperative and postoperative periods for total knee arthroplasty, but is less defined in unicompartmental knee arthroplasty (UKA). The goal of this study was to elucidate the risk of developing PJI after intra-articular corticosteroid injection (IACI) into a post UKA knee. A retrospective review of a nationwide administrative claims database was performed from January 2015 to October 2020. Patients who underwent UKA and had an ipsilateral IACI were identified and matched 2:1 to a control group of primary UKA patients who did not receive IACI. Multivariate logistic analyses were conducted to assess differences in PJI rates at 6 months, 1 year, and 2 years. A total of 47,903 cases were identified, of which 2,656 (5.5%) cases received IACI. The mean time from UKA to IACI was 355 days. The incidence of PJI in the IACI group was 2.7%, compared to 1.3% in the control group. The rate of PJI after IACI was significantly higher than the rate in the control group at 6 months, 1 year, and 2 years (all P <.05). The majority of PJI occurred within the first 6 months following IACI (75%). In this study, IACI in a UKA doubled the risk of PJI compared to patients who did not receive an injection. Surgeons should be aware of this increased risk to aid in their decision-making about injecting into a UKA. III, retrospective comparative study. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the outcomes of primary reverse total shoulder arthroplasty (rTSA) using glenoid bone grafting (BG rTSA) with primary rTSA using augmented glenoid baseplates (Aug rTSA) with a minimum 2-year follow-up. A total of 520 primary rTSA patients treated with 8° posterior glenoid augments (n = 246), 10° superior glenoid augments (n = 97), or combined 10° superior/8° posterior glenoid augments (n = 177) were compared with 47 patients undergoing glenoid bone grafting for glenoid bone insufficiency. The mean follow-up was 37.0(±16) and 53.0(±27) months, respectively. Outcomes were analyzed preoperatively and at the latest follow-up using conventional statistics and stratification by minimum clinically important difference (MCID) and substantial clinical benefit (SCB) thresholds where applicable. Radiographs were analyzed for baseplate failure, and the incidences of postoperative complications and revisions were recorded. The glenoid Aug rTSA cohort had greater improvements in patient-reported outcome measures (PROMs) and range of motion when compared with the BG rTSA group at a minimum of 2-year follow-up, including Simple Shoulder Test, Constant score, American Shoulder and Elbow Surgeons score, University of California Los Angeles score, Shoulder Pain and Disability Index score, shoulder function, Shoulder Arthroplasty Smart score, abduction, and external rotation (P <.05). Patient satisfaction was higher in the Aug rTSA group compared with the BG rTSA group (P =.006). The utilization of an augmented glenoid component instead of glenoid bone grafting resulted in approximately 50% less total intraoperative time (P <.001), nearly 33% less intraoperative blood loss volume (P <.001), approximately 3-fold less scapular notching (P <.01), and approximately 8-fold less adverse events requiring revision (P <.01) when compared with the BG rTSA cohort. Aside from SCB for abduction, the Aug rTSA cohort achieved higher rates of exceeding MCID and SCB for every PROM compared with BG rTSA. More specifically, 77.6% and 70.2% of the Aug rTSA achieved SCB for American Shoulder and Elbow Surgeons and Shoulder Pain and Disability Index vs. 55% and 48.6% in the BG rTSA, respectively (P =.003 and P =.013). The present midterm clinical and radiographic study demonstrates that the utilization of an augmented baseplate for insufficient glenoid bone stock is superior as judged by multiple PROMs and range of motion metrics when compared with bone graft augmentation at minimum 2-year follow-up. In addition, when analyzed according to MCID and SCB thresholds, the use of augmented baseplates outperforms the use of glenoid bone grafting. Complication and revision rates also favor the use of augmented glenoid baseplates over glenoid bone grafting. Long-term clinical and radiographic follow-up is necessary to confirm that these promising midterm results are durable. [ABSTRACT FROM AUTHOR]

Racial differences in elective abdominal aortic aneurysm (AAA) repair outcomes have been previously reported; however, data on racial differences in ruptured AAA (rAAA) repair outcomes remain limited. This study assessed in-hospital and long-term mortality after rAAA repair in Black versus White patients. The Vascular Quality Initiative database was queried to identify all Black and White patients who underwent open or endovascular rAAA repair between 2003 and 2019. Baseline demographic and clinical characteristics were recorded, and independent t test and χ2 test were performed to assess differences between groups. In-hospital and 8-year mortality rates were the primary outcomes. Univariate and multivariate logistic regression and Cox proportional hazards analyses were conducted to analyze associations between race and outcomes. Overall, 310 Black patients and 4679 White patients underwent rAAA repair. A greater proportion of Black patients underwent endovascular repair (73.2% vs 56.1%). Black patients had a lower mean age and were more likely to be female, with a greater proportion being Medicaid insured (9.7% vs 2.1%) or uninsured (4.8% vs 3.3%). Although Black patients were more likely to be current smokers and have hypertension, diabetes, and congestive heart failure, they were not more likely to receive risk reduction medications. The time from symptom onset to incision or access was higher for Black patients (median, 12.0 hours vs 7.0 hours). Similarly, the time from hospital admission to intervention was higher for Black patients (median, 2.8 hours vs 1.3 hours). In-hospital mortality was lower in Black patients (20.0% vs 28.6%; odds ratio [OR], 0.63; 95% confidence interval [CI], 0.47-0.83); however, this did not persist after adjusting for baseline characteristics (adjusted OR, 0.58; 95% CI, 0.30-1.07; P =.09). Furthermore, the 8-year survival was not different between groups (50.4% vs 46.6%; hazard ratio, 0.85; 95% CI, 0.57-1.26; P =.42), even when stratified by repair type. This study identified racial differences in demographic, clinical, and procedural characteristics for patients undergoing rAAA repair. In particular, the door-to-intervention time for Black patients of 2.8 hours does not meet the Society for Vascular Surgery recommendation of 90 minutes. Despite these differences, the 8-year mortality is similar for Black and White patients. These differences should be investigated further, and there are opportunities to improve rAAA care for Black patients. [ABSTRACT FROM AUTHOR]