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This study was designed to examine demographics of University of Nebraska Medical Center College of Dentistry graduates over a recent 10-year period and factors related to their choice of rural or urban practice. Findings were compared to similar previous studies to analyze trends.Using data from the annual Health Professions Tracking Service 2019 Dentistry Profile survey, we examined the demographic information of 169 graduates from 2009 to 2018 practicing in Nebraska at the end of 2018. We analyzed factors such as rural or urban high school graduation, gender, and other background information to explore associations with their 2018 practice location (urban vs. rural) using chi-square tests and logistic regression.This study found that some demographic variables were associated with future practice location. Specifically, a higher proportion of graduates of rural high schools chose to work in a rural location (60%) relative to those who graduated from an urban high school (18%) (p0.0001). A higher proportion of men (50%) selected rural practice compared to women (33%) (p = 0.02). Only 17 graduates who attended high school outside of Nebraska stayed to practice in Nebraska, and there was a lower proportion of these graduates working in rural locations (18%) relative to in-state high school graduates (45%) (p = 0.03).We found significant positive associations between dentists who chose rural practice and demographic factors such as being rural high school graduates, male, and in-state predental residents. Our findings differ from descriptive results of similar previous studies.

In all levels of disc herniations the absolute surgical indications include deteriorating neurological deficits with myelopathy or cauda equina syndrome. However, this review summarized the relative indications for surgery in each level. In cervical disc herniation (CDH), the indications for surgery consist of six months of persisting symptoms, not responding to conservative treatment. However, high-quality studies are lacking, and a randomized controlled trial is now underway to clarify the indications. In thoracic disc herniation (TDH), the indications for surgery comprise failure of conservative measures and/or worsening neurological symptoms. Moreover, giant calcified thoracic disc herniations or myelopathy signs on magnetic resonance imaging, even in the absence of neurological symptoms, may benefit from surgical treatment as a preventive measure. In lumbar disc herniation (LDH), the indications for surgery include imaging confirmation of LDH, consistent with clinical findings, and failure to improve after six weeks of conservative care. Cite this article: EFORT Open Rev 2021;6:526-530. DOI: 10.1302/2058-5241.6.210020

Study designA systematic review reporting on the efficacy of an ERAS protocol in patients undergoing spinal fusion for AIS.ObjectiveTo systematically evaluate the relevant literature pertaining to the efficacy of ERAS protocols with respect to the length of stay, complication, and readmission rates in patients undergoing posterior spinal corrective surgery for AIS.Summary of background dataERAS is a multidisciplinary approach aimed at improving outcomes of surgery by a specific evidence-based protocol. The rationale of this rapid recovery regimen is to maintain homeostasis so as to reduce the postoperative stress response and pain. No thorough review of available information for its use in AIS has been published.MethodsA systematic review of the English language literature was undertaken using search criteria (postoperative recovery AND adolescent idiopathic scoliosis) using the PRISMA guidelines (Jan 1999-May 2020). Isolated case reports and case series with ResultsOf a total of 24 articles, 10 studies met the inclusion criteria (9 were Level III and 1 of level IV evidence) and were analyzed. Overall, 1040 patients underwent an ERAS-type protocol following posterior correction of scoliosis and were compared to 959 patients following traditional protocols. There was a significant reduction in the length of stay in patients undergoing ERAS when compared to traditional protocols (p p = 0.19) or readmission rates (p = 0.30). Each protocol employed a multidisciplinary approach focusing on optimal pain management, nursing care, and physiotherapy.ConclusionThis systematic review demonstrates advantages with ERAS protocols by significantly reducing the length of stay without increasing the complications or readmission rates as compared to conventional protocols. However, current literature on ERAS in AIS is restricted largely to retrospective studies with non-randomized data, and initial cohort studies lacking formal control groups.Level of evidence3.

PURPOSE: We report a case of a patient with an acute symptomatic Schmorl node (SN) that spontaneously resolved with characteristic imaging findings. The extensive hematological investigations also allow some insight as to the likely pathophysiology of the painful lesion. METHODS: Case report of an acute symptomatic SN. RESULTS: A fit and athletic 44-year-old female participant in a competitive paddling event developed atypical thoracic pain and was admitted for further investigation. Normal blood results included complete blood cell count, clotting, and D-dimer. Creatine phosphokinase was 63 U/L (reference < 167 U/L) and troponin I levels were not raised. Her only hematological abnormality was an elevated C-reactive protein (CRP) at 60.2 mg/L (reference < 5 mg/L). Magnetic resonance imaging (MRI) scan showed signal hyperintensity involving T7 vertebral body, surrounding an enlarged SN. Patient was given oral nonsteroidal anti-inflammatory drugs, opioid analgesia, and gradually mobilized. After 3 days, the pain had sufficiently subsided and CRP was 17.8 mg/L. Follow-up MRI scan showed some reduction in the T2 hyperintensity and size of the intraosseous herniation. Patient gradually returned to full activities and had no recurrence of symptoms. MRI scan 8 months after the initial scan showed almost complete resolution of the T2 hyperintensity and pan-vertebral marrow edema. CONCLUSION: Symptomatic SN should be part of the differential diagnosis of unexplained thoracolumbar pain. Modality of choice for diagnosis would be MRI. Once diagnosed, several treatment options are available with the most likely being spontaneous resolution of symptoms and bone healing within a few months. The conservative approach is recommended when the symptoms can be medically well controlled.

Most spinal metastases are detected late, and thus, the impact of treatment on the health-related quality of life (HRQOL) is an important consideration. This study investigated the HRQOL following surgery for spinal metastases. A prospective study of patients operated for symptomatic spinal metastases, at a single tertiary referral spine centre (2011–2013). Data were collected pre-operatively and up to 2 years following surgery (if alive). The HRQOL assessment was performed using recognised systems including the Frankel score (neurological status), EQ-5D, and the Oswestry Disability Index. A total of 199 patients were studied (median age 65 years, 43% (86) F; 57% (113) M). The Frankel score improved significantly after surgery in 69 patients (35%), worsened in 17 (8%), with 20/39 patients regaining the ability to walk (51%). All the HRQOL scores improved significantly following surgery. The complication rate was 27% and median survival 270 days, and 44 patients (22%) survived at 2 years. This large prospective study showed that surgical treatment for spinal metastases significantly improved the HRQOL.

Objective To test whether patients with spontaneous osteonecrosis of the knee (SONK) are characterized by abnormal levels of thrombophilia-associated factors. Design Twenty-five patients with SONK were recruited. Inclusion criteria were (1) age >40 years, (2) acute onset knee pain not precipitated by trauma, and (3) MRI findings consistent with SONK. Exclusion criteria were (1) history of cancer and chemotherapy and (2) factors associated with secondary osteonecrosis. Blood tests included 13 thrombophilia-associated factors that were either heritable mutations or acquired factors. Descriptive statistics included medians, ranges, means, and standard deviations. Mann-Whitney test was used to compare thrombophilia-associated factor levels between the sexes. Spearman’s rank test was used to test correlations between smoking status and each thrombophilia-associated factor. Level of significance was set at 0.05. Results Median patient age was 62 years (range, 44-77 years). There were 16 (64%) men. Thirteen (52%) patients had thrombophilia-associated factor abnormalities of which 9 were elevated fibrinogen but this was less than 1 standard deviation above norm threshold. Other findings were 3 patients with marginally decreased antithrombin below norm threshold, low protein S Ag in only 1 patient, and factor V Leiden mutation heterozygosity in 2 patients, which was not higher than normal population prevalence. Thrombophilia-associated factors neither differed between sexes ( P = nonsignificant) nor correlated with smoking status ( P = nonsignificant). Conclusion Thrombophilia-associated factor abnormalities in patients with SONK were minimal. Therefore, clinical workup and treatment strategy in this disease should focus on addressing alternative etiologies leading to abnormal subchondral bone metabolism with focal osteopenia.

Background:There are limited data regarding associated factors of return to sports activities at more than 5 years after anterior cruciate ligament (ACL) reconstruction.Purpose:To test interrelationships between patient characteristics, concomitant articular lesions, graft laxity, and maintenance of sports activities at 5 to 10 years after ACL reconstruction. It was hypothesized that at 5 to 10 years after the operation in young adult men, maintenance of greater activity level and better knee function would be associated with greater preinjury activity level, younger age at reconstruction, absence of concomitant articular lesions, and minimal graft laxity at follow-up.Study Design:Case series; Level of evidence, 4.Methods:One hundred six men with autologous hamstring ACL reconstruction between the ages of 18 and 35 years were reviewed at 5 to 10 years after surgery. Excluded patients had contralateral ACL tear, revision reconstruction, or another injury impairing function. Fifty-five patients were eligible and available for follow-up. Independent variables included preinjury Tegner score, time interval from injury to surgery, smoking status, age, articular lesions, KT side-to-side difference, and pivot-shift grade. Main outcome measures were Tegner activity level, International Knee Documentation Committee (IKDC) subjective score, and Knee injury and Osteoarthritis Outcome Scale (KOOS) score at 5 to 10 years after surgery.Results:Greater Tegner activity level at follow-up was associated in a regression model with greater preinjury Tegner activity level (correlation coefficient, 0.423; P = .01), lower KT difference (correlation coefficient, –0.278; P = .04), and negative pivot shift (correlation coefficient, –0.277; P = .05). Younger age at operation predicted return to greater Tegner activity level in a univariate analysis (correlation coefficient, –0.266; P = .05) but not in a regression model (not significant). Chondral lesions at surgery predicted lower IKDC subjective scores (71.4 ± 14.3 vs 84.1 ± 11.5; P < .01) and KOOS scores but did not affect maintenance of sports activities.Conclusion:At 5 to 10 years after autologous hamstring ACL reconstruction in young men, predictors of greater sports activity level are primarily high preinjury activity level and reestablishment of knee laxity. Younger age at operation and moderate chondral lesions have lower impact in this respect.

Plates incubated for 48 h showed significantly higher (0.01

Cooking and chemical properties were investigated on beef patties formulated from UDSA Choice or Cutter-Canner cow beef; processed by either grinding, flaking, or flaking, then grinding; and subjected to final broiling from the precooked or raw state. Quality grade of lean exerted minimal influence on the cooking and chemical properties. Precooked patties had more total cooking losses than nonprecooked patties. For precooked patties made from flaked beef, most of the losses in weight; and configuration occurred during precooking rather than final broiling. The opposite was true for precooked patties made from gro and beef. Thus, in order to maximize yield and minimize configurational changes the method of patty processing should be considered in deciding whether to precook patties prior to freezing.

Raw milk samples were diluted with distilled water or distilled water with added phosphate buffer as recommended by Standard Methods for the Examination of Dairy Products. The standard plate counts were higher in diluent without phosphate buffer with both high and low count milk. The higher counts were significant when analyzed by a nonparametric sign test or a t-test of differences but were not significant with an analysis of variance technique. Reproducibility was not statistically different in the two diluents. It is suggested that the use of phosphate buffer for raw milk bacteria counts be discontinued until information showing definite advantages is provided.

The red raspberry cultivars ’Latham,’ ’Viking,’ ’Newburgh,’ ’Willamette,’ ’Sumner,’ ’Rideau’ and ’Lloyd George’ were tested for their differential abilities to support colonies of the aphid Amphorophora agathonica. These cultivars were grown at Agassiz, B.C. and Burlington, Vt., and counts of the natural populations of A. agathonica that developed on each cultivar except Lloyd George were subjected to statistical analyses. Latham, Viking, and Newburgh differed significantly in relative numbers of aphids between the two locations. The numbers on Willamette and Sumner were relatively similar. Rideau and Lloyd George were immune at each location. This suggests that the populations at the two locations belonged to the same race with respect to their ability to colonize red raspberry cultivars. The differences observed in Latham, Viking, and Newburgh might relate to variations in genotypes of the race.

Seven-day-old hypocotyls of 149 bean cultivars were inoculated with Rhizoctonia solani and incubated in a growth chamber for 72 hours at 30°C. Based on the mean size of the largest lesion, and 10 most resistant cultivars were: ‘Dwarf Horticultural Long Pod’, ‘Yellow Eye’, ‘White Kidney’, ‘Romano Pole’, ‘French Horticultural’, ‘Red Kidney’, ‘Manitou’, ‘Sutter Pink’, ‘Wren’s Egg’, and ‘Red Mexican UI 37’. The mean largest lesion for ‘Dwarf Horticultural Long Pod’ (the most resistant) was 3.0 mm2 while that for the Bush Blue Lake 274 (susceptible) was 64.4 mm2. These 10 cultivars were further tested using 5 different isolates of R. solani. ‘Yellow Eye’ was the most resistant to all 5 isolates with a mean largest lesion size of 10.0 mm2 while ‘Bush Blue Lake’ had a mean lesion size of 90.9 mm2. The root rot ratings were highly correlated with the areas of the largest lesion, and the number of lesions. ‘White Kidney’ was the only white-seeded resistant cultivar.