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Background:. As the incidence of shoulder arthroplasty rises at exponential rates, race is an important consideration, as racial disparities have been reported in lower-extremity arthroplasty in the United States. Our study sought to examine these disparities. Methods:. Using the National Inpatient Sample (NIS) database, all anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (RSA) procedures from 2011 to 2017 were analyzed. The patients were divided into the Black, Hispanic, and White groups. Results:. Overall, 91.4% of the patients undergoing any shoulder arthroplasty procedure were White, 4.75% were Black, and 3.85% were Hispanic. Age and sex-standardized RSA utilization rates (per 100,000) in White patients increased by 139% from 6.94 in 2011 to 16.60 in 2017. The disparity for Black patients, compared with White patients, was 118% in 2011 and 124% in 2017; the disparity for Hispanic patients was 112% in 2011 and 103% in 2017. Similar disparities in aTSA utilization rates were seen; when compared with White patients, there was a 150% disparity in 2011 and a 197% disparity in 2017 for Black patients, and a 169% disparity in 2011 and a 262% disparity in 2017 for Hispanic patients. Finally, Blacks had a higher rate of non-home discharge, longer length of stay, and higher overall costs, while Hispanics had a longer length of stay and higher cost than Whites. Conclusions:. Despite many efforts to reduce racial disparities in health-care utilization, the chasm in shoulder arthroplasty in the United States appears to be large and widening further. The exponential increase in utilization of shoulder arthroplasty has not been shared equally among races, and the disparities are larger than those reported in lower-extremity arthroplasty.

IntroductionAngiogenesis in pituitary tumors is not fully understood, and a better understanding could help inform new pharmacologic therapies, particularly for aggressive pituitary tumors.Materials and Methods219 human pituitary tumors and 12 normal pituitary glands were studied. Angiogenic genes were quantified by an angiogenesis qPCR array and a TaqMan probe-based absolute qPCR. Angiogenesis inhibition in pituitary tumors was evaluated in vitro with the endothelial tube formation assay and in vivo in RbΔ19 mice.Results71 angiogenic genes, 40 of which are known to be involved in sprouting angiogenesis, were differentially expressed in pituitary tumors. Expression of endothelial markers CD31, CD34, and ENG was significantly higher in pituitary tumors, by 5.6, 22.3, and 8.2-fold, respectively, compared to in normal pituitary tissue. There was no significant difference in levels of the lymphatic endothelial marker LYVE1 in pituitary tumors compared with normal pituitary gland tissue. Pituitary tumors also expressed significantly higher levels of angiogenesis growth factors, including VEGFA (4.2-fold), VEGFB (2.2), VEGFC (19.3), PGF (13.4), ANGPT2 (9.2), PDGFA (2.7), PDGFB (10.5) and TGFB1 (3.8) compared to normal pituitary tissue. Expression of VEGFC and PGF was highly correlated with the expression of endothelial markers in tumor samples, including CD31, CD34, and ENG (endoglin, a co-receptor for TGFβ). Furthermore, VEGFR inhibitors inhibited angiogenesis induced by human pituitary tumors and prolonged survival of RbΔ19 mice.ConclusionHuman pituitary tumors are characterized by more active angiogenesis than normal pituitary gland tissue in a manner consistent with sprouting angiogenesis. Angiogenesis in pituitary tumors is regulated mainly by PGF and VEGFC, not VEGFA and VEGFB. Angiogenesis inhibitors, such as the VEGFR2 inhibitor cabozantinib, may merit further investigation as therapies for aggressive human pituitary tumors.

Epigenetic modification of chromatin is involved in non-malignant pituitary neoplasia by causing abnormal expression of tumor suppressors and oncogenes. These changes are potentially reversible, suggesting the possibility of targeting tumor cells by restoring the expression of epigenetically silenced tumor suppressors. The role of the histone deacetylase (HDAC) family in pituitary tumorigenesis is not known. We report that HDAC2 and 3, Class I HDAC members, are highly expressed in clinically non-functioning pituitary adenomas (NFPAs) compared to normal pituitary (NP) samples as determined by RT-PCR and immunohistochemical staining (IHC). Treatment of a human NFPA derived folliculostellate cell line, PDFS, with the HDAC3 inhibitor RGFP966 for 96 hours resulted in inhibition of cell proliferation by 70%. Furthermore, the combination of RGFP966 with a methyltransferase/DNMT inhibitor, 5’-aza-2’-deoxycytidine, led to the restoration of the expression of several tumor suppressor genes, including STAT1, P16, PTEN, and the large non-coding RNA tumor suppressor MEG3, in PDFS cells. Our data support the hypothesis that both histone modification and DNA methylation are involved in the pathogenesis of human NFPAs and suggest that targeting HDACs and DNA methylation can be incorporated into future therapies.

Background: Research clerkships are usually designed as individual learning projects focusing on research skills training, such as research design, data analysis and reporting. When the COVID‐19 pandemic triggered an urgent need for digital education, we redesigned a research clerkship with the challenging aim to maintain original quality for more students than usual with limited teaching staff. Approach: We introduced the concept of a research learning community (RLC) with co‐teaching and co‐learning to a group of 14 students and seven teaching faculty using digital platforms. Small groups of students participated in the RLC, which was supervised weekly by the teachers. Research experts were continuously involved and led workshops. Evaluation: Using a qualitative design, we analysed experiences from the perspectives of students and faculty. We performed an inductive thematic content analysis of three focus group interviews and used 14 student reports for triangulation. The results indicate that apart from developing research skills, students valued peer assistance, attention to uncertainty and learning beyond individual research projects. The teachers/research experts reported that co‐teaching and co‐learning had contributed to their professional development. In terms of organisation, students and faculty recognised that the RLC model allowed for interdisciplinary learning, facilitated by a digital platform. Implications: To develop students' research skills, embedding a clerkship in an RLC is an attractive alternative to individual research clerkships. The obligatory learning goals are met. Co‐learning and co‐teaching foster faculty's and students' professional development. When translating to other curricula, we recommend stating common goals in addition to individual objectives. [ABSTRACT FROM AUTHOR]

We have searched for radio pulsations toward 49 Fermi Large Area Telescope (LAT) 1FGL Catalog γ -ray sources using the Green Bank Telescope at 350 MHz. We detected 18 millisecond pulsars (MSPs) in blind searches of the data; 10 of these were discoveries unique to our survey. 16 are binaries, with eight having short orbital periods P B < 1 day. No radio pulsations from young pulsars were detected, although three targets are coincident with apparently radio-quiet γ -ray pulsars discovered in LAT data. Here, we give an overview of the survey and present radio and γ -ray timing results for the 10 MSPs discovered. These include the only isolated MSP discovered in our survey and six short- P B binary MSPs. Of these, three have very-low-mass companions (M c ≪ 0.1 M ⊙) and hence belong to the class of black widow pulsars. Two have more massive, nondegenerate companions with extensive radio eclipses and orbitally modulated X-ray emission consistent with the redback class. Significant γ -ray pulsations have been detected from nine of the discoveries. This survey and similar efforts suggest that the majority of Galactic γ -ray sources at high Galactic latitudes are either MSPs or relatively nearby nonrecycled pulsars, with the latter having on average a much smaller radio/ γ -ray beaming ratio as compared to MSPs. It also confirms that past surveys suffered from an observational bias against finding short- P B MSP systems. [ABSTRACT FROM AUTHOR]

Abstract Background Antibiotic exposure in term infants has been associated with later obesity. Premature, very-low-birth-weight (birth weight ≤ 1500 g) infants in the neonatal intensive care unit frequently are exposed to antibiotics. Our hypothesis was that in preterm infants, there is a positive linear and dose-dependent relationship between antibiotic exposure and growth from birth through 12 months’ corrected age. Methods Retrospective analysis of prospectively collected data of all antibiotic use among inborn, preterm (≤32 weeks’ gestation), very-low-birth-weight infants admitted to the neonatal intensive care unit at Parkland Memorial Hospital and followed in the Low Birth Weight Clinic at Children’s Medical Center, Dallas, TX. Antibiotic use was quantified by days of therapy which was compared with weight and length parameters at birth, 36 weeks’ postmenstrual age, and 2, 4, 6, and 12 months’ corrected age. The change in weight and length z-scores from birth to all subsequent age points was calculated. Stepwise multivariate regression analysis was performed to determine predictors of weight, length, and weight-for-length delta z-scores from birth to each subsequent age point. Results During the 18-month study, 161 infants received a median of 11 (IQR, 5.5–19.5) antibiotic days of therapy which was not associated with weight or length delta z-scores from birth through 12 months’ corrected age. Conclusion Association of prolonged antibiotic use and neonatal morbidities and mortality may override the potential association with increased weight gain in the NICU and beyond.

BackgroundAccurately and unobtrusively testing the effects of snoring and sleep interventions at home has become possible with recent advances in digital measurement technologies. ObjectiveThe aim of this study was to examine the effectiveness of using an adjustable bed base to sleep with the upper body in an inclined position to reduce snoring and improve sleep, measured at home using commercially available trackers. MethodsSelf-reported snorers (N=25) monitored their snoring and sleep nightly and completed questionnaires daily for 8 weeks. They slept flat for the first 4 weeks, then used an adjustable bed base to sleep with the upper body at a 12-degree incline for the next 4 weeks. ResultsOver 1000 nights of data were analyzed. Objective snoring data showed a 7% relative reduction in snoring duration (P=.001) in the inclined position. Objective sleep data showed 4% fewer awakenings (P=.04) and a 5% increase in the proportion of time spent in deep sleep (P=.02) in the inclined position. Consistent with these objective findings, snoring and sleep measured by self-report improved. ConclusionsNew measurement technologies allow intervention studies to be conducted in the comfort of research participants’ own bedrooms. This study showed that sleeping at an incline has potential as a nonobtrusive means of reducing snoring and improving sleep in a nonclinical snoring population.

This study aimed to carry out a Ramadan observance (RO) on anthropometric, psychosocial, physiological, and postural characteristics of patients with chronic obstructive pulmonary disease (COPD). Twenty COPD patients were evaluated. Tests performed 1 week before Ramadan (C), and during the second (R-2) and the fourth weeks of Ramadan (R-4) included standard anthropometry, spirometry, a quality of life questionnaire (VQ11), a 6-minute walking test (6MWT), measurement of maximal voluntary contraction force of the quadriceps (MVC), Timed Get Up and Go (TUG), Berg Balance Scale (BBS), and Unipedal Stance (UST). During R-2, there were significant decreases in forced vital capacity and forced expiratory volumes, 6MWT distance, MVC, BBS, and UST, with significant increases in TUG and significant changes in VQ11. During R-4, there was some recovery, but all variables remained significantly different from initial control data. To conclude, RO adversely affects pulmonary function, exercise performance, postural balance, and quality of life in COPD, with some recovery by the R-4. Although a number of functional consequences remain to be elucidated, functional losses were insufficient to limit daily living in our sample, but further studies are recommended in those with more severe COPD, paying particular attention to postural disturbances and a possible increase in the risk of falls.