Search

Background The purpose of this study was to determine if addition of CT to axillary radiographs (AXR) alters preoperative decision making for shoulder arthroplasty. Methods Preoperative deidentified images (XR alone and XR with CT) of 50 patients with glenohumeral arthritis were reviewed independently by 3 reviewers in a blinded fashion. Each reviewer graded images for glenoid wear pattern as simple (Walch A1 or B1) or advanced [A2, B2, C]), adequacy of AXR and need for advanced imaging. The reviewers determined a preoperative plan for all patients based on XR alone vs. XR and CT including the arthroplasty type (anatomic or reverse total shoulder) and their plan for treating glenoid wear (eccentric or standard reaming vs. bone graft or augment). Kappa values (κ) were calculated to determine inter-rater agreement and consistency among multiple reviewers. Fisher's exact test was used to assess any difference in preoperative plan once the shoulders were separated into simple and advanced glenoid wear patterns. Results The 3 reviewers agreed that quality of AXRs was significantly inadequate (P Conclusion Axillary radiographs are often inadequate for preoperative planning in shoulder arthritis with advanced glenoid wear patterns (Walch A2, B2, C types). Addition of CT imaging to radiographs in shoulder arthritis with advanced glenoid wear can affect the preoperative decision with respect to type of shoulder arthroplasty and/or plan for addressing glenoid wear (reaming, bone graft or augmented glenoids). Level of evidence Level IV

With all of the constraints facing residency programs today, such as increasing work-hour restrictions, a changing economy and its accompanying financial pressures, and the current generation of physicians' enhanced interest in lifestyle quality, it is imperative for orthopaedic educators to identify and select the best possible residents to fill our residency programs. Several recent editorials from major orthopaedic journals have discussed identifying resident quality and maximizing success during residency. One such commentary stressed that continuously refining and improving resident education and training are of the utmost importance to the future of orthopaedic surgery (and, indeed, to the future of medicine) because doing so today will facilitate the continued recruitment of top medical students to orthopaedic surgery1. In another recent editorial, in The Journal of Bone and Joint Surgery (American Volume), Deputy Editor Marc Swiontkowski remarked that the Orthopaedic Residency Review Committee's expanded role within the Accreditation Council for Graduate Medical Education (ACGME) has recently enabled us to attain a number of important goals in postgraduate education with respect to interviewing and selecting candidates for residency as well as educating and counseling residents during residency2. In order to build on these improvements, Swiontkowski stressed that we must continue to innovate and improve all aspects of orthopaedic surgery postgraduate education. Therefore, it is important for orthopaedic surgery postgraduate training programs to evaluate the means by which they identify and select the candidates who are likely to succeed during residency and, ultimately, in practice. Moreover, identifying predictors or factors associated with success during orthopaedic surgery residency is critical knowledge for program directors, selection committees, and students. Currently and for the last twenty years, resident selection decisions have been made by a committee of faculty at our institution that reviews all of the applications and then generates a consensus ranking …

Exosomes are nanovesicles that are released from cells as a mechanism of cell-free intercellular communication. Only a limited number of proteins have been identified from the plasma exosome proteome. Here, we developed a multi-step fractionation scheme incorporating gel exclusion chromatography, rate zonal centrifugation through continuous sucrose gradients, and high-speed centrifugation to purify exosomes from human plasma. Exosome-associated proteins were separated by SDS-PAGE and 66 proteins were identified by LC-MS/MS, which included both cellular and extracellular proteins. Furthermore, we identified and characterized peroxisome proliferator-activated receptor-gamma (PPARgamma), a nuclear receptor that regulates adipocyte differentiation and proliferation, as well as immune and inflammatory cell functions, as a novel component of plasma-derived exosomes. Given the important role of exosomes as intercellular messengers, the discovery of PPARgamma as a component of human plasma exosomes identifies a potential new pathway for the paracrine transfer of nuclear receptors.