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Introduction: Sarcopenia, or the loss of lean muscle mass, is associated with increased morbidity and mortality as well as poor surgical outcomes. The aim of our study was to utilize computed tomography imaging to obtain the total psoas volume (TPV) as a potential marker of sarcopenia. We then investigated the relationship between TPV and outcomes in surgically managed hip fracture patients, particularly their discharge disposition., Methods: A retrospective review of surgically managed hip fracture patients at a single institution level one American College of Surgeons verified trauma center between 2017 and 2022 was performed. The primary endpoint was patient disposition after hospitalization. TPV was collected via three dimension reconstruction of computed tomography images. Student's t-test was used to assess for association between TPV and demographic variables. Binary logistic regressions were performed to examine variables that could predict patient disposition among the patients., Results: We identified 64 surgically managed hip fracture patients, 57.8% of whom were males, with a median age of 74 (IQR: 62, 88). Black race (244.4 vs. 190.3, P = 0.032) and younger age (252.2 vs. 181.8, P = 0.004) were associated with higher TPV. Male patients with higher TPV had a higher likelihood of being discharged home as opposed to a skilled nursing or rehabilitation facility (251.3 vs. 191.1, P = 0.02). In multivariable analysis adjusting for sex, race, body mass index, and age, males with a higher TPV were more likely to be discharged home (odds ratio: 1.012; 95% confidence interval: 1.004 1.020; P = 0.028)., Conclusions: Psoas muscle volume can be used to predict which male patients are likely to be discharged home postoperatively after surgically managed traumatic hip fracture., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Tranexamic acid (TXA) has been used as an adjunct in traumatic hemorrhage management. Outside of trauma, TXA has been used to limit blood loss across multiple surgical fields. TXA has also been found to have an immune-modulating effect, reducing postoperative infection rates. However, the relationship between TXA and infection rates in trauma patients is unclear., Methods: We performed a single-institution retrospective cohort analysis of 364 trauma patients who underwent massive transfusion protocol activation at a level-one trauma level center over a 7-y period. Patients were placed into two groups based on TXA administration (No TXA and TXA). Minors, patients on anticoagulants, pregnant patients, and those who died upon arrival or were hospitalized for less than 1 d were excluded. Univariate and multivariate analysis with propensity score matching were used to evaluate the association between TXA and infection rates., Results: Sixty-one patients (16.8%) received TXA, and 303 patients (83.2%) did not. TXA was associated with an increased risk of infection on univariate analysis (P = 0.007). However, on multivariate analysis after propensity score matching, TXA was not associated with infection (P = 0.975) while total hospital days and total ventilator days were associated with an increased risk of infection (P = 0.012, P = 0.014)., Conclusions: Our study found no association between TXA and infection rates among our patient cohort. While TXA remains an important adjunct in trauma resuscitation, we did not find an association between TXA and infection in trauma patients., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Groin hernia repair is one of the most commonly performed surgical procedures and is often performed by surgical interns and junior residents. While traditionally performed open, minimally invasive (MIS) groin hernia repair has become an increasingly popular approach. The purpose of this study was to determine the trends in MIS and open inguinal and femoral hernia repair in general surgery residency training over the past two decades., Methods: Accreditation Council for Graduate Medical Education (ACGME) national case log data of general surgery residents from 1999 through 2022 were reviewed. We collected means and standard deviations of open and MIS inguinal and femoral hernia repairs. Linear regression and ANOVA were used to identify trends in the average annual number of open and MIS hernia repairs logged by residents. Cases were distinguished between level of resident trainees: surgeon-chief (SC) and surgeon-junior (SJ)., Results: From July 1999 to June 2022, the average annual MIS inguinal and femoral hernia repairs logged by general surgery residents significantly increased, from 7.6 to 47.9 cases (p < 0.001), and the average annual open inguinal and femoral hernia repairs logged by general surgery residents significantly decreased, from 51.9 to 39.7 cases (p < 0.001). SJ resident results were consistent with this overall trend. For SC residents, the volume of both MIS and open hernia repairs significantly increased (p < 0.001)., Conclusions: ACGME case log data indicates a trend of general surgery residents logging overall fewer numbers of open inguinal and femoral hernia repairs, and a larger proportion of open repairs by chief residents. This trend warrants attention and further study as it may represent a skill or knowledge gap with significant impact of surgical training., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Dendriform pulmonary ossification (DPO) is a rare condition characterised by the formation of bones in lung tissues. This case report describes the first reported case of DPO in a patient with sickle cell disease (SCD), identifying DPO as a potential pulmonary consequence of SCD., Competing Interests: None

Background: Like many physiologic processes, Time of Day may influence postural control and gait. A better understanding of diurnal variations in postural control and gait may help to improve diagnoses, reduce falls, and optimize rehabilitation and training routines. This review summarizes the current literature that addresses these questions., Research Question: Does time of day affect postural control and gait?, Methods: We searched PubMed, Google Scholar, and IEEE using a combination of keyword and MeSH terms. We included papers that studied human subjects and assessed gait or postural control as a function of time of day. We evaluated the quality of the identified papers based on nine assessment criteria and analyzed them considering the topic (postural control or gait), age, and characteristics of the conducted assessments. We then quantitatively synthesized the results across studies using a meta-analytical approach (i.e., Hedges' g model)., Results: Twenty-two papers considered the relationship between time of day and postural control, and eleven considered the relationship between time of day and gait. Six studies found that postural control was best in the morning, four described postural control being best in the afternoon, four described optimal postural control in the evening, and eight reported no time of day effect. Two studies found gait best in the morning, five described gait best in the afternoon, two described optimal gait in the evening, and two reported no time of day effect. The results of the quantitative analysis suggest that both postural control and gait were best in the evening., Significance: While there is no clear consensus on whether there is a time of day effect for postural control and gait, the findings of this review provide initial evidence suggesting that a small but statistically significant effect exists in favor of the evening. Standardized testing, including repeated and continuous evaluations, may help provide more definitive information on time of day influences on postural control and gait., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Alemtuzumab is a monoclonal anti-CD52 antibody prescribed to treat relapsing-remitting multiple sclerosis (RRMS). Alemtuzumab affects the balance of the immune system by depleting circulating lymphocytes, leading to the formation of a new immune repertoire less likely to induce autoimmune attack against CNS myelin. We collected real-world data of RRMS patients treated with alemtuzumab. We assessed relapse rate, disability progression, and MRI-related disease activity over a 24 month period. Our study included 35 RRMS patients (19 female and 16 male) with a mean age of 37.3 years (SD = 10.5). The patient cohort had a mean disease duration of 10.4 years, median previous disease modifying treatments (DMTs) of 3.0, and a median expanded disability status scale (EDSS) score of 4.0 (IQR 2.5-6.0). Neurological disability remained stable during treatment and there was no statistically significant change in EDSS score. Prior to treatment, the median relapse rate was 2.0 (IQR 1.0-3.0); after treatment the median relapse rate was 0.0. This 2.0 decrease in relapse rate is statistically significant (p < 0.0001). Moreover, the treated patients exhibited a statistically significant decrease in gadolinium (GD) enhancing lesions on MRI [both in number (p < 0.005) and volume (p < 0.005)]. Thirty-three percent of patients reached NEDA-3 (no evidence of disease activity) status by the end of treatment. In a real-world setting, alemtuzumab treatment significantly decreased relapse rate and GD-enhancing lesions while preventing disability progression. Tolerability of treatment was high, with patients experiencing only minor adverse events., (© 2020. Belgian Neurological Society.)

Neuroaxonal injury and loss result in the release of cytoskeleton components, including neurofilaments, into the cerebrospinal fluid and peripheral blood. Once released, neurofilaments are highly immunogenic, inducing a specific antibody response. Anti-neurofilament antibody levels correlate with the progression of diverse neurological diseases; however, their role both in the pathogenesis of disease and as a tool for monitoring disease progression is not well understood. This study reviews the current literature on anti-neurofilament antibodies. We suggest the testing of anti-neurofilament antibodies be further developed for diagnosis and targeted for treatment., (Copyright © 2020 Elsevier B.V. All rights reserved.)