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IntroductionSubjective visual impairment (VI) is related to cognition in cognitively unimpaired (CU) older adults, mild cognitive impairment (MCI) patients, and Alzheimer’s disease (AD) patients. The utility of subjective VI as an indicator for domain-specific cognitive impairment is unknown.MethodsWe used the National Eye Institute Visual Function Questionnaire (NEI-VFQ-25 item) and a neuropsychological battery to assess the relationship between subjective VI and domain-specific cognitive performance in CU older adults (N = 58) and MCI patients (N = 16).ResultsThe CU group showed a positive relationship between subjective VI and visuospatial performance. CU older adults at high risk for AD demonstrated a unique relationship between subjective VI and attention, processing speed, and executive function. Peripheral vision was related to domain-specific performance in the patient group.DiscussionSubjective VI complaints may indicate potential for domain-specific cognitive decline in visuospatial performance, executive function, processing speed, and attention in older adults.

This document intends to auscultate the potential wind and mini-hydraulic energy in the lower basins of the rivers of the mountain ranges; given its topology, taking as an example the lower basin of the Ocoña river in Arequipa Peru, characterized by the canyoning of the mountain range, from the coast (0 masl) to the highlands (4,500 masl), and by the important flow hydraulic when descending from the highlands to the Pacific Ocean, in an area of 16,045 km2. For this, the wind speed has been recorded in anemometers placed at 6, 12, and 18 m above the surface. The section of the river and its speed have also been determined, the height of the river's water level has been recorded; all with an hourly periodicity. With this information we have determined the potential for wind and mini-hydro energy in this characteristic place. Wind speeds in the order of 10 m/s have been obtained, with a persistence of 8 h a day. As for the mini-hydraulic, with a minimum flow of 50 m3/s there is a persistence greater than 90 %. In conclusion, the potential of wind, mini-hydro, and combined energy of the place is sufficient to satisfy various energy demands, from very small to very large.

Introduction Verbal de-escalation is an essential skill for physicians across specialties and is the first-line intervention for patients who present with agitation. Training in verbal de-escalation for medical students is less robust compared to other health care disciplines. We describe the creation and evaluation of a novel verbal de-escalation curriculum for third- and fourth-year medical students on their psychiatry clerkship rotation. Method We developed a simulation using standardized patient (SP) methodology and a dedicated reflection session, implementing it in the third-year psychiatry clerkship. Participants in the scenario received targeted feedback from their peers and SPs. The sessions were video recorded, and a random sample was selected and reviewed to identify key observations and themes from student performance. Results A total of 139 students participated in the encounter. One hundred twenty-two of 125 students (82%) stated the activity met the learning objectives, with 108 (86%) assigning the letter grade A to the activity. Written feedback indicated that the majority of students believed the activity to be realistic, instructive, and helpful but felt the SPs de-escalated too quickly. Video review of the encounters found that while the students effectively used the skills, many jumped to a quick fix, and some offered inappropriate choices to end the encounter. Discussion This SP activity was effective in allowing students to practice skills in a safe setting and was valued by students. In the future, adding another workshop in the fourth year could facilitate higher retention and practice of skills.

Introduction: Euglycemic diabetic ketoacidosis (DKA) (glucose 18 years old, met criteria for DKA on initial laboratories (pH ≤7.30, serum bicarbonate ≤18 millimoles per liter [mmol/L], anion gap ≥10), and were managed via a standardized DKA order set. Patients were divided into euglycemic (18 mmol/L and first long-acting insulin were similar. Incidence of hypoglycemia (

BackgroundMitochondrial health has gained attention in a number of diseases, both as an indicator of disease state and as a potential therapeutic target. The quality and amount of mitochondrial DNA (mtDNA) and RNA (mtRNA) can be important indicators of mitochondrial and cell health, but are difficult to measure in complex tissues.MethodsmtDNA and mtRNA in zebrafish retina samples were fluorescently labeled using RNAscope™ in situ hybridization, then mitochondria were stained using immunohistochemistry. Pretreatment with RNase was used for validation. Confocal images were collected and analyzed, and relative amounts of mtDNA and mtRNA were reported. Findings regarding mtDNA were confirmed using qPCR.ResultsSignals from probes detecting mtDNA and mtRNA were localized to mitochondria, and were differentially sensitive to RNase. This labeling strategy allows for quantification of relative mtDNA and mtRNA levels in individual cells. As a demonstration of the method in a complex tissue, single photoreceptors in zebrafish retina were analyzed for mtDNA and mtRNA content. An increase in mtRNA but not mtDNA coincides with proliferation of mitochondria at night in cones. A similar trend was measured in rods.DiscussionMitochondrial gene expression is an important component of cell adaptations to disease, stress, or aging. This method enables the study of mtDNA and mtRNA in single cells of an intact, complex tissue. The protocol presented here uses commercially-available tools, and is adaptable to a range of species and tissue types.

Background Hip fractures in the geriatric population are frequently encountered. There is increasing focus on minimizing the delay to surgery in these patients. This study was designed to evaluate factors responsible for a delay to surgery in a geriatric hip fracture population and how time to surgery affects mortality. Methods A retrospective cohort of patients sustaining low energy geriatric hip fractures in either an American College of Surgeons (ACS) verified Level 1 trauma center or a local university affiliated community teaching hospital were reviewed. The following variables were evaluated as independent risk factors for delay to surgery: demographic data, surgical details, use of cardiology resources, treatment center, and comorbidities. As a secondary objective, the effect of time to surgery on 1 year mortality was analyzed. Results 1157 patients met inclusion criteria. The following factors increased the risk of delay to surgery greater than 48 hours: male sex, treatment in a community hospital (versus trauma center), older age, multiple comorbidities (eg, cardiovascular-related conditions or other fractures), cardiology consultation, and an American Society of Anesthesiologists physical status score of 3 or 4. Cardiology consultation was the strongest independent predictor of risk for delay to surgery of >48 hours (odds ratio, 6.68; 95% confidence interval, 4.40 to 10.14; P < .001). The 1-year mortality of patients did not differ when surgical treatment occurred before 48 hours or after 48 hours (Log-rank test P = .109). Conclusion The presence of cardiovascular comorbidities and cardiology consultations can delay surgical treatments for hip fractures in patients greater than 65 years old, but the delay did not influence 1-year all-cause mortality. Level of Evidence Level IV.

Background: Diabetic ketoacidosis (DKA) is a rare complication of immune checkpoint inhibitor (ICI) therapy, a treatment used for many malignancies. Case reports: We present two cases of adults, one without a prior history of diabetes, presenting to the Emergency Department (ED) with DKA induced by ICI therapy.Why should an emergency physician be aware of this? The emergency physician should be aware of the spectrum of complications associated with ICI therapy, and should remain vigilant in patients presenting with symptoms of DKA and/or unexplained elevated anion gap metabolic acidosis, as DKA in patients without a history of diabetes mellitus can go unrecognized.

Background: The Sonoran Desert region, encompassing most of southern Arizona, has an extreme climate that is famous for dust storms known as haboobs. These storms lead to decreased visibility and potentially hazardous driving conditions. In this study we evaluate the relationship between haboob events and emergency department (ED) visits due to motor vehicle collisions (MVCs) in Phoenix, Arizona. Methods: This study is a retrospective analysis of MVC-related trauma presentations to Phoenix, AZ, hospitals before and following haboob dust storms. These events were identified from 2009–2017 primarily using Phoenix International Airport weather data. De-identified trauma data were obtained from the Arizona Department of Health Services (ADHS) Arizona State Trauma Registry (ASTR) from seven trauma centers within a 10-mile radius of the airport. We compared MVC-related trauma using six- and 24-hour windows before and following the onset of haboob events. Results: There were 31,133 MVC-related trauma encounters included from 2009–2017 and 111 haboob events meeting meteorological criteria during that period. There was a 17% decrease in MVC-related ED encounters in the six hours following haboob onset compared to before onset (235 vs 283, P = 0.04), with proportionally more injuries among males ( P < 0.001) and higher mortality ( P = 0.02). There was no difference in frequency of presentations ( P = 0.82), demographics, or outcomes among the 24-hour pre-and post-haboob groups. Conclusion: Haboob dust storms in Phoenix, Arizona, are associated with a decrease in MVC-related injuries during the six-hour period following storm onset, likely indicating the success of public safety messaging efforts. Males made up a higher proportion of those injured during the storms, suggesting a target for future interventions. Future public-targeted weather-safety initiatives should be accompanied more closely by monitoring and evaluation efforts to assess for effectiveness.

Dachshunds are at significant risk of experiencing thoracolumbar intervertebral disk herniation (IVDH) during their lifetimes. Standard of care includes advanced imaging, surgical intervention, and postoperative rehabilitation. Conservative management is commonly recommended for cases where the standard of care is declined, and little is known about the prognosis of treatment with conservative management and rehabilitation (nonsurgical rehabilitation). This retrospective cohort study assessed 12-week functional outcome and recurrence of clinical signs in 40 dachshunds with T3-L3 myelopathy presumed to be due to Hansen's Type I disc herniation, treated with nonsurgical rehabilitation. The overall prognosis was good with 34 of 40 (85.0%, 95% CI 70.2–94.2) dachshunds achieving functional pet status by 12 weeks postinjury. Modified Frankel Score at presentation was significantly (p < 0.001) higher in dogs with a positive 12-week outcome compared to dogs that did not recover by 12 weeks. All 27 dogs with motor function at presentation had a positive outcome. Of the 9 dogs exhibiting paraplegia with intact deep nociception at presentation, 7 dogs (77.8%) had achieved a positive outcome by 12 weeks. None of the 4 dogs persistently lacking deep nociception had a positive outcome. Among 27 dogs with a positive outcome for whom follow-up records were available, the 1- and 2-year recurrence rates for T3-L3 myelopathy were 5 and 11%, respectively. Nonsurgical rehabilitation should be considered in dachshunds with mild to moderate T3-L3 myelopathy or in severe cases when advanced imaging and surgical intervention are not possible.

Abstract Background Bacteria adapted to live within animals can protect their hosts against harmful infections. Beyond antagonism with pathogens, a ‘defensive’ bacterial symbiont could engage in additional interactions with other colonizing micro-organisms. A single bacterium might thus have cascading ecological impacts on the whole microbiome that are rarely investigated. Here, we assess the role of a defensive symbiont as a driver of host-associated microbiota composition by using a bacterial species (Enterococcus faecalis) that was previously experimentally adapted to a nematode host model (Caenorhabditis elegans). Results An analysis of 16S rRNA data from C. elegans exposed to E. faecalis and subsequently reared in soil, reveal that symbiont adaptation to host environment or its protective potential had minimal impact on microbiota diversity. Whilst the abundance of Pseudomonas was higher in the microbiota of hosts with protective E.faecalis (and another protective species tested), a few other genera – including Serratia and Salinispora – were less abundant in hosts colonized by all E. faecalis strains. In addition, the protective effect of E. faecalis against virulent Staphylococcus aureus pathogens was maintained despite multi-species interactions within the microbiota. Conclusions Our results reveal the degree to which a new, evolving symbiont can colonise and maintain pathogen-resistance with minimal disruption to host microbiota diversity.

Herein, we describe the development of a paper-based device to detect nucleic acids of pathogens of interest in complex samples using loop-mediated isothermal amplification (LAMP) by producing a colorimetric response visible to the human eye. To demonstrate the utility of this device in emerging public health emergencies, we developed and optimized our device to detect SARS-CoV-2 in human saliva without preprocessing. The resulting device was capable of detecting the virus within 60 min and had an analytical sensitivity of 97% and a specificity of 100% with a limit of detection of 200 genomic copies/μL of patient saliva using image analysis. The device consists of a configurable number of reaction zones constructed of Grade 222 chromatography paper separated by 20 mil polystyrene spacers attached to a Melinex® backing via an ARclean® double-sided adhesive. The resulting device is easily configurable to detect multiple targets and has the potential to detect a variety of pathogens simply by changing the LAMP primer sets.

Microalgae can be cultivated on waste dark fermentation effluents containing volatile fatty acids (VFA) such as acetate or butyrate. These VFA can however inhibit microalgae growth at concentrations above 0.5-1 gC.L–1. This study used the model strain Chlorella sorokiniana to investigate the effects of acetate or butyrate concentration on biomass growth rates and yields alongside C:N:P ratios and pH control. Decreasing undissociated acid levels by raising the initial pH to 8.0 allowed growth without inhibition up to 5 gC.L–1 VFAs. However, VFA concentration strongly affected biomass yields irrespective of pH control or C:N:P ratios. Biomass yields on 1.0 gC.L–1 acetate were around 1.3-1.5 gC.gC–1 but decreased by 26-48% when increasing initial acetate to 2.0 gC.L–1. This was also observed for butyrate with yields decreasing up to 25%. This decrease in yield in suggested to be due to the prevalence of heterotrophic metabolism at high organic acid concentration, which reduced the amount of carbon fixed by autotrophy. Finally, the effects of C:N:P on biomass, lipids and carbohydrates production dynamics were assessed using a mixture of both substrates. In nutrient replete conditions, C. sorokiniana accumulated up to 20.5% carbohydrates and 16.4% lipids while nutrient limitation triggered carbohydrates accumulation up to 45.3%.

Objective: This study is a preliminary evaluation of how perceived barriers towards transition might impact patient attitudes towards their own readiness and ability to transition, self-efficacy towards their IBD, and the allocation of treatment responsibility. Methods: A sample of 81 young adults with IBD were seen for standard care in a Young Adult Clinic (YAC). Patients completed questionnaires on perceived transition barriers; perceived confidence, importance, motivation, and readiness towards transition and transfer; IBD self-efficacy; and allocation of treatment responsibility. Path model analyses were conducted. Results: Not knowing how and who to transfer to and not understanding insurance details were the most commonly endorsed perceived barriers to transition. A significant relationship was found between the attitude toward transition and allocation of treatment responsibility, but no meaningful indirect effects were found from perceived barriers to the allocation of treatment responsibility, using attitudes toward transition as an intervening variable. The relationship between perceived barriers and allocation of treatment responsibility was at least partially explained by examining the intervening effects of attitudes toward transfer and self-efficacy. Conclusions: The study findings carry important implications for targets of clinical intervention to assist young adults with IBD in engaging in their health care and ultimately transferring into adult care.

The ongoing pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused unprecedented damage to the global economy. Diagnostic testing is a key factor in limiting virus transmission and safeguarding public health. We present the fabrication process of a paper-based device that uses reverse-transcription loop-mediated isothermal amplification (RT-LAMP) to detect SARS-CoV-2 in complex matrices by providing a colorimetric response apparent to the naked eye. Because of LAMP's functionality, this device just requires a simple heat source (e.g., water bath, incubator), it can be deployed in resource-constrained areas and can be used as a supplement to current point-of-care (POC) and community testing procedures. Since the test is based on nucleic acids, the testing platform itself lends to further applications including food safety monitoring, animal diagnostics, etc. simply by changing the specific primers. • We developed a platform capable of on-paper detection of SARS-CoV-2 using colorimetric reporters that produce responses visible to the naked eye. • The platform is easily reconfigurable to target different pathogens by changing the primer sets, and multiplexing is possible by adding additional reaction sites to the device.

The impact of repetitive magnetic stimulation (rTMS) on cortex varies with stimulation parameters, so it would be useful to develop a biomarker to rapidly judge effects on cortical activity, including regions other than motor cortex. This study evaluated rTMS-evoked EEG potentials (TEP) after 1 Hz of motor cortex stimulation. New features are controls for baseline amplitude and comparison to control groups of sham stimulation. We delivered 200 test pulses at 0.20 Hz before and after 1500 treatment pulses at 1 Hz. Sequences comprised AAA = active stimulation with the same coil for test–treat–test phases (n = 22); PPP = realistic placebo coil stimulation for all three phases (n = 10); and APA = active coil stimulation for tests and placebo coil stimulation for treatment (n = 15). Signal processing displayed the evoked EEG waveforms, and peaks were measured by software. ANCOVA was used to measure differences in TEP peak amplitudes in post-rTMS trials while controlling for pre-rTMS TEP peak amplitude. Post hoc analysis showed reduced P60 amplitude in the active (AAA) rTMS group versus the placebo (APA) group. The N100 peak showed a treatment effect compared to the placebo groups, but no pairwise post hoc differences. N40 showed a trend toward increase. Changes were seen in widespread EEG leads, mostly ipsilaterally. TMS-evoked EEG potentials showed reduction of the P60 peak and increase of the N100 peak, both possibly reflecting increased slow inhibition after 1 Hz of rTMS. TMS-EEG may be a useful biomarker to assay brain excitability at a seizure focus and elsewhere, but individual responses are highly variable, and the difficulty of distinguishing merged peaks complicates interpretation.

AIM: The aim of this paper is to describe the various strategies employed to mitigate communication impairments and to argue that illness experiences may be captured through methods other than audio-tape recordings of spoken words. BACKGROUND: This paper explores issues surrounding the collection of interview data from participants experiencing communication impairments. It derives from a qualitative interview study, which enquired into experiences of living with a percutaneous endoscopic gastrostomy. This is an artificial route created directly into the stomach for long-term delivery of nutrition to people who are unable to take nutrition via the normal route. However, in many cases the physical impairments that led to their requirement for this form of feeding also made speech, and hence interviewing, very difficult. DISCUSSION: Capturing illness experiences from participants with impaired communication requires a reconsideration of both practical strategies and broader methodological issues. In addition to the adaptation of data generation strategies a re-examination of the complexities inherent in the meaning of 'patient experience' is required. This paper explores the utility of verbal and other interactional input from carers to explore further dimensions of this experience. CONCLUSION: Qualitative research that seeks to capture the meanings of illness from the patient's perspective needs to be adapted to embrace different modes of communicating the illness experience. [ABSTRACT FROM AUTHOR]

Diabetic ketoacidosis is a leading cause of morbidity and mortality in diabetic patients, and its diagnosis should be timely and accurate. SGLT2 inhibitors are a new class of antidiabetic medications that increase the renal excretion of glucose. It is thought that increased urinary excretion of glucose will mask hyperglycemia during DKA. This can lead to a delayed diagnosis of DKA and worsen outcomes. In this report, we detail a case of euglycemic DKA in a patient who presented to the Emergency Department meeting criteria for septic shock.

Venous thromboembolism occurs when a deep vein thrombosis travels to the lungs and forms a pulmonary embolism. Low-molecular-weight heparins are a mainstay in the treatment and prevention of venous thromboembolism and should be initiated promptly due to substantial morbidity and mortality. A rare side effect of low-molecular-weight heparins is major bleeding, which also carries a significant morbidity and mortality rate. Here, we present a case of a fatal retroperitoneal hematoma in a patient being treated with enoxaparin for bilateral pulmonary emboli.

We designed a study to determine whether chronic encephalopathy occurs in elite, active soccer players resulting from repetitive heading of the soccer ball. Studies have suggested that the cumulative effects of heading a ball can cause a chronic brain syndrome similar to dementia pugilistica, which is seen in professional boxers. Twenty of 25 members of the U.S. Men's National Soccer Team training camp (average age, 24.9; average years of soccer, 17.7), who completed a questionnaire on head injury symptoms and had magnetic resonance imaging of the brain, were compared with 20 age-matched male elite track athletes. The soccer players were surveyed about playing position, teams, number of headers, acute head injuries, and years of playing experience. An exposure index to headers was developed to assess a dose-response effect of chronic heading. The soccer and track groups were questioned regarding alcohol use and history of acute head traumas. Questionnaire analysis and magnetic resonance imaging demonstrated no statistical differences between the two groups. Among the soccer players, symptoms and magnetic resonance imaging findings did not correlate with age, years of play, exposure index results, or number of headers. However, reported head injury symptoms, especially in soccer players, correlated with histories of prior acute head injuries (r = 0.63). These findings suggest that any evidence of encephalopathy in soccer players relates more to acute head injuries received playing soccer than from repetitive heading. [ABSTRACT FROM AUTHOR]

We present an 88-year-old male with simultaneous T-cell prolymphocytic leukemia and stable smoldering myeloma with excellent initial response to three months of alemtuzumab. The patient relapsed at twelve months with severe cutaneous disease. Biopsy of a representative plaque demonstrated CD30 positivity in rare malignant lymphocytes. The patient demonstrated no response to reintroduction with a full course of alemtuzumab. He was therefore treated with brentuximab vedotin, resulting in partial remission of skin involvement that persisted for three months.

In Europe, the agricultural biogas sector is currently undergoing fast developments, and cattle manure constitutes an important feedstock. Batch dry digester processes with leachate recirculation prove to be particularly interesting for small-scale plants. However, their startup being relatively slow, the process could be facilitated by co-digestion with energy crops. In this study, Miscanthus xgiganteus was chosen for its high biomass yields and low input requirements. The carbohydrate accessibility of this lignocellulosic biomass is limited but may be improved with alkali pretreatment. The efficiency of lime (CaO) pretreatment with low water addition on the biochemical methane potential (BMP) of miscanthus was investigated through two experimental designs (CaO concentrations ranged between 2.5 and 17.5% and pretreatment lasted 1, 3, or 5 days). The pretreated miscanthus was then co-digested with cattle manure in dry leach bed reactors. CaO pretreatments led to a 14–37% improvement of miscanthus BMP, and a 67–227% increase in the first-order kinetics constant; a high contact time was shown to favor methane production. According to these results and to industrial requirements, miscanthus was pretreated with 5 and 10% CaO for 5 days, then co-digested with manure in dry leach bed reactors. Nevertheless, the promising results of the BMP tests were not validated. This could be related to the high water absorption capacity of miscanthus.

Since the incident of World Trade Center (WTC) in USA, Indonesia has become an easy target for the next terrorism. Counterterrorist campaigns can be undertaken by military and paramilitary forces. Counterterrorism refers to proactive policies that specifically seek to eliminate terrorist environments and groups, Regardless of which policy is selected, the ultimate goal of counterterrorism is clear: to save lives by proactively preventing or decreasing the number of terrorist attacks. But, so far the Government of Indonesia is only able to capture the terrorists but is unable to eradicate terrorism. Therefore, the government of Indonesia still needs a comprehensive ways to counter terrorism in Indonesia

Esthesioneuroblastoma (ENB) is a neuroendocrine tumor that typically manifests as advanced stage malignancy in the superior nasal cavity. The hallmark symptoms include nasal obstruction and epistaxis, which result from local tissue invasion. Atypical clinical features can also arise and must be considered when diagnosing and treating ENB. These can include origin in an ectopic location, unusual presenting symptoms, and associated paraneoplastic syndromes. The case described here reports a nasal cavity ENB with atypical clinical features that occurred in a young female. Her tumor was low grade, appeared to arise primarily from the middle nasal cavity, and presented as syndrome of inappropriate antidiuretic hormone (SIADH). She also became pregnant shortly after diagnosis, which had implications on her surgical management. We review the atypical features that uncommonly occur with ENB and the clinical considerations that arise from these unusual characteristics.

Lands devoted to military use are globally important for the production of ecosystem services and for the conservation of biodiversity. The United States has one of the largest military land estates in the world, and most of these areas occur in water-limited landscapes. Despite many of these areas receiving intense or sustained disturbance from military training activities, the structure and function of ecosystems contained within their boundaries continue to provide critical benefits to people across spatial scales. The land owned and managed by the Department of Defense is subject to regulation across local, state, and federal governing bodies, constraining and shaping both how land management is conducted and how ecosystem services are prioritized. Here, we explored the supply of ecosystem services from military lands in dryland areas of the United States using key indicators of ecosystem services: biodiversity estimates derived from range maps, ecosystem productivity estimates from satellite observations, and spatially explicit, hierarchical ecosystem classifications. Additionally, we utilized content analysis of the environmental management plans of these areas to describe the unique set of demands and regulatory constraints on these areas. We found that the US military land estate in drylands contains many types of ecosystems and provides a large and diverse supply of ecosystem services, comparable to the sum of services from public lands in these areas. Additionally, the degree to which the ecosystem services concept is captured in environmental management plans is strongly shaped by the language of the governing legislation that mandated the use of environmental management plans in these areas, although these plans do not explicitly address land management using the concept of ecosystem services. Collectively, our findings suggest that military use and management of land represents an important source of ecosystem services, that military land use can be considered a cultural ecosystem service unto itself, and that top-down regulation can affect how these services are identified and valued. Our work highlights the need for the research and conservation communities to quantify ecosystem services from individual military installations so that both services and biodiversity can be safeguarded in an era of military conflict across the globe., (© 2024 The Ecological Society of America.)

The impacts of global climate change on dryland fungi have been understudied even though fungi are extremely sensitive to changes in the environment. Considering that many fungi are pathogens of plants and animals, including humans, their responses to anthropogenic change could have important implications for public health and food security. In this study, we investigated the potential physiological responses (i.e., metatranscriptomics) of pathogenicity and stress in dryland fungi exposed to global change drivers, drought, and the physical disturbance associated with land use. Specifically, we wanted to assess if there was an increase in the transcription of genes associated to pathogenicity and stress in response to global change drivers. In addition, we wanted to investigate which pathogenicity and stress genes were consistently differentially expressed under the different global change conditions across the heterogeneous landscape (i.e., microsite) of the Chihuahuan desert. We observed increased transcription of pathogenicity and stress genes, with specific genes being most upregulated in response to global change drivers. Additionally, climatic conditions linked to different microsites, such as those found under patches of vegetation, may play a significant role. We provide evidence supporting the idea that environmental stress caused by global change could contribute to an increase of pathogenicity as global climate changes. Specifically, increases in the transcription of stress and virulence genes, coupled with variations in gene expression, could lead to the onset of pathogenicity. Our work underscores the importance of studying dryland fungi exposed to global climate change and increases in existing fungal pathogens, as well as the emergence of new fungal pathogens, and consequences to public health and food security., Importance: The effects of global climate change on dryland fungi and consequences to our society have been understudied despite evidence showing that pathogenic fungi increase in abundance under global climate change. Moreover, there is a growing concern that global climate change will contribute to the emergence of new fungal pathogens. Yet, we do not understand what mechanisms might be driving this increase in virulence and the onset of pathogenicity. In this study, we investigate how fungi respond to global change drivers, physical disturbance, and drought, in a dryland ecosystem in terms of pathogenicity and stress. We find that indeed, under global change drivers, there is an increase in the transcription and expression of genes associated to pathogenicity and stress, but that microclimatic conditions matter. Our study shows the importance of investigating dryland fungi exposed to global climate change and impacts on our society, which may include threats to public health and food security., Competing Interests: The authors declare no conflict of interest.

Purpose: To compare the biomechanical properties of quadriceps tendon (QT) graft stitch methods using 3 different suture systems for anterior cruciate ligament reconstruction., Methods: A total of 48 QTs were harvested from cadaveric knee specimens (age: 73 ± 7 years; range, 66-86 years). Samples were randomly divided into 3 groups where different suture needle systems were used to create 2 stitch methods: whipstitch (WS) and locking stitch (LS). Surgeons performed each technique to 5 stitches, each 0.5 cm apart. Stitching time was recorded. Samples were preconditioned and then underwent cyclic loading, followed by load to failure. Stiffness (N/mm), ultimate failure load (N), peak-to-peak displacement (mm), elongation (mm), and failure displacement (mm) were recorded., Results: WS and LS were equivalent across stiffness, ultimate load, and peak-to-peak displacement within groups 2 and 3. In group 1, the LS was stiffer than the WS, but the WS achieved a higher ultimate load. For all groups, the LS achieved lower elongation and failure displacement than the WS, with significant differences in groups 1 and 2. Within each stitching method, equivalence was determined for total elongation and ultimate failure load for all 3 suture system groups. For WS samples, group 1 all failed from suture breakage, and both groups 2 and 3 had instances of failure from suture pull-through. All LS samples failed from suture breakage., Conclusions: Both LS and WS provide adequate mechanical properties in each of the 3 suture systems. Differences in performance do exist; however, each method shows equivalent total elongation and ultimate failure load for all 3 suture systems. LS may be preferred over WS due to lower mean elongation and failure displacement., Clinical Relevance: There is an increased use of QT grafts in for anterior cruciate ligament reconstruction. However, there have been a limited number of studies comparing various stitching methods and optimizing techniques for QT graft fixation. This study may provide important information to surgeons about which suture techniques have better biomechanical profiles., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: This study was funded by Winter Innovations and supported by the National Science Foundation under Grant No. 2112103. M.A.D. received financial support by the Foundation for Orthopedic Research and Education and research grant Winter Innovations. A.B. has received speaking and lecture fees and travel reimbursement from Sanara MedTech and Zimvie. S.E.J. has received speaking and lecture fees and travel reimbursement Arthrex, CGG Medical, Vericel Corporation, GE Healthcare, Breg, and S-I Bone and has received consultation or advisory fees, funding or grants, and nonfinancial support from Arthrex and CGG Medical. All other authors (E.A.B., J.G.D.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Competing Interests: None of the authors identify a conflict of interest.

Purpose: To assess the biomechanical performance of different stitching methods using a suturing device by comparing the elongation, stiffness, failure load, and time to stitch completion in cadaveric semitendinosus tendons (STs) and quadriceps tendons (QTs)., Methods: A total of 24 STs and 16 QTs were harvested from cadaveric knee specimens (N = 40). Samples were randomly divided into 2 groups: whipstitch (WS) and whip-lock (WL) stitch. Both tendon ends were clamped to a graft preparation stand, and a 2-part needle was used to place 5 stitches, each 0.5 cm apart. Stitching time was recorded. Samples were preconditioned and then underwent cyclic loading from 50 to 200 N at 1 Hz for 500 cycles, followed by load-to-failure testing at 20 mm/min. Stiffness (in newtons per millimeter), ultimate failure load (in newtons), peak-to-peak displacement (in millimeters), elongation (in millimeters), and failure displacement (in millimeters) were recorded., Results: Completion of the WS was significantly faster than the WL stitch in the ST ( P < .001) and QT ( P  = .004). For the ST, the WL stitch exhibited higher ultimate failure loads and construct stiffness than the WS. Regarding the QT, the WL stitch showed higher stiffness and displacement than the WS; however, the ultimate failure load was higher for the WS in the QT. The ultimate failure load in the QT was higher than that in the ST for both stitches. In the ST, only 25% of WSs and 100% of WL stitches failed due to suture breakage. In the QT, suture breakage led to the failure of 100% of both the WL stitches and WSs., Conclusions: In the ST, the WL stitch resulted in improved biomechanical performance through higher ultimate load and fewer failures from tissue damage compared with the WS. In the QT, both the WS and the WL stitch showed similar biomechanical performance with ultimate failure loads above established clinical failure thresholds., Clinical Relevance: Various types of ligament and tendon injuries require suturing to enable repair or reconstruction. The success of ligament or tendon surgery often relies on soft-tissue quality. It is important to investigate the biomechanical properties of stitching techniques that help preserve soft-tissue quality as a step to determining their clinical suitability., Competing Interests: The authors report the following potential conflicts of interest or sources of funding: This study was funded by Winter Innovations and was supported by the 10.13039/100000001National Science Foundation (under grant No. 2112103). M.A.D. receives a research grant from Winter Innovations (grant No. 2112103, paid directly to the Foundation for Orthopaedic Research and Education). In addition, the Foundation for Orthopaedic Research and Education has received a research grant from DePuy Mitek. A.B. receives support from Sanara MedTech and ZIMVIE, outside the submitted work. S.E.J. receives support from Arthrex, CGG Medical, Vericel, GE Healthcare, BREG, and SI-BONE, outside the submitted work. All other authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (© 2023 The Authors.)

Purpose: To investigate the viability of cells collected with an in-line-suction autologous tissue collector from the tissue byproducts of arthroscopic anterior cruciate ligament (ACL) reconstruction, to characterize cells from different tissue types, and to identify mesenchymal stem cells., Methods: Patients aged 14 to 50 years with ACL injuries requiring arthroscopic reconstruction surgery were offered enrollment and screened for participation. In total, 12 patients were enrolled in the descriptive laboratory study. Arthroscopic byproduct tissue was collected with an in-line-suction autologous tissue collector from 4 intraoperative collection sites for each patient: ACL stump, ACL fat pad, notchplasty debris, and tunnel drilling debris. All tissue samples were digested using collagenase, and the derived cellular populations were analyzed in vitro, characterizing cellular viability, proliferative potential, qualitative multipotent differentiation capacity, and cell-surface marker presence., Results: An equivalent mass of arthroscopic byproduct tissue was taken from each of the 4 intraoperative collection sites (1.12-1.61 g, P  = .433), which all showed an average viability of at least 99.95% and high average total nucleated cells (≥1.37 × 10 7 cells/mL). No significant differences in collected mass ( P  = .433), cellular viability ( P  = .880), or total nucleated cells ( P  = .692) were observed between the 4 byproduct tissues. The byproduct tissues did exhibit significant differences in monocyte ( P  = .037) and red blood cell ( P  = .038) concentrations, specifically with greater values present in the ACL stump tissue. Cells from all byproduct tissues adhered to plastic cell culture flasks. Significant differences were found between colony-forming unit fibroblast counts of the 4 byproduct tissues when plated at 10 6 ( P  = .003) and 10 3 ( P  = .016) cells as the initial seeding density. There was a significant relationship found between both the starting concentration (χ 2  = 32.7, P < .001) and the byproduct tissue type (χ 2  = 30.4, P < .001) to the presence of ≥80% confluency status at 10 days. Cells obtained from all 4 byproduct tissues qualitatively showed positive tri-lineage (adipocyte, osteoblast, chondroblast) differentiation potential compared with negative controls under standardized in vitro differentiation conditions. Cells derived from all 4 byproduct tissues expressed cell-surface antigens CD105+, CD73+, CD90+, CD45-, CD14-, and CD19- (>75%), and did not express CD45 (<10%). There were no statistically significant differences in cell-surface antigens between the four byproduct tissues., Conclusions: This descriptive laboratory study demonstrated that cells derived from arthroscopic byproduct tissues of ACL reconstruction remain viable when collected with an in-line-suction autologous tissue collector and these cells meet the ISCT criteria to qualify as mesenchymal stem cells., Clinical Relevance: It is known that viable mesenchymal stem cells reside in byproduct tissue of anterior cruciate ligament reconstruction surgery (ACLR). Practical methods to harvest these cells at the point of care require further development. This study validates the use of an in-line-suction autologous tissue collector for the harvest of viable mesenchymal stem cells after ACLR., Competing Interests: The authors report the following potential conflicts of interest or sources of funding: This work was financially supported in part by a grant from Arthrex, Grant Number US19013. A.W.A. reports a grant from Arthrex, during the conduct of the study, and personal fees from Arthrex, outside the submitted work. E.A.B. reports a grant from Arthrex, during the conduct of the study, and personal fees from Arthrex, outside the submitted work. R.V.O. reports a grant from Arthrex, during the conduct of the study, and personal fees from Arthrex, outside the submitted work. S.E.J. reports a grant from Arthrex, during the conduct of the study, and personal fees from Arthrex, outside the submitted work. All other authors (J.J.C., C.A.R.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (© 2023 The Authors.)

Background: Essential tremor (ET) can be debilitating. Treatments for ET include beta-blockers and surgical interventions. Low-intensity focused ultrasound (LIFU) may offer an office-based non-invasive alternative., Objective: This pilot open label clinical trial explores safety, feasibility, and potential efficacy of LIFU in treatment of ET., Methods: We report outcomes from the first 10 participants in this IRB-approved trial of LIFU for treatment of ET. The ventral intermediate nucleus of the thalamus (Vim) was targeted using structural and functional MRI. Participants underwent eight 10-min sessions of LIFU targeting the contralateral (Vim) to the most affected hand. Safety was closely monitored; Global Rating of Change (GRC) and The Essential Tremor Rating Scale (TETRAS) scores were collected., Results: No adverse effects were reported. Eight participants reported a GRC ≥2. TETRAS performance subscale demonstrated clinically significant improvement in all participants., Conclusion: Preliminary findings support LIFU's safety and feasibility. The potential efficacy encourages additional sham-controlled studies., Competing Interests: Declaration of competing interest This study did not receive any external funding. Authors CMD, JRS, JMH, KDM, JKG, SAB, KRH, KCE, TK, and SEJ have no conflicts of interest to disclose. Author AB is the founder and CEO of Brainsonix Corp., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) developed by the National Institutes of Health provides a standardized method for collecting outcomes data from sports medicine patient populations. Methods: The objective of this scoping review is to report on PROMIS utilization in orthopedic sports medicine research and practice. We searched PubMed, ScienceDirect, and Cochrane Library using keywords and database-specific subject headings to identify studies that reported PROMIS utilization. Inclusion criteria were the use or mention of PROMIS in any population of patients commonly treated by orthopedic sports medicine physicians. Results: Following a screening process, we included 67 studies published from 2019 through 2022 in this review. A near-equal distribution of studies was published per year during this period. Twenty-four domains were assessed across the studies. Among studies with adult populations, the Pain Interference (45 studies, 67%) and Physical Function (37 studies, 55%) domains were the 2 most reported by researchers. Upper Extremity (4 studies, 6%) and Mobility (3 studies, 4%) were the 2 most used domains in studies involving pediatric populations. Conclusion: Our results demonstrate consistent utilization of PROMIS domains in the field of sports medicine. Researchers commonly used PROMIS with other legacy measures, comparing the scores to one another to assess responsiveness and validity. This review provides evidence that PROMIS domains are being used to collect data on a variety of factors related to sports medicine patient outcomes that may help physicians better understand the complexities of the recovery and rehabilitation process., (©2023 by the author(s); Creative Commons Attribution License (CC BY).)

Background: It is theorized that the lack of a synovial lining after anterior cruciate ligament (ACL) injury and ACL reconstruction (ACLR) contributes to slow ligamentization and possible graft failure. Whether graft maturation and incorporation can be improved with the use of a scaffold requires investigation., Purpose: To evaluate the safety and efficacy of wrapping an ACL autograft with an amnion collagen matrix and injecting bone marrow aspirate concentrate (BMAC), quantify the cellular content of the BMAC samples, and assess 2-year postoperative patient-reported outcomes., Study Design: Randomized controlled trial; Level of evidence, 2., Methods: A total of 40 patients aged 18 to 35 years who were scheduled to undergo ACLR were enrolled in a prospective single-blinded randomized controlled trial with 2 arms based on graft type: bone-patellar tendon-bone (BTB; n = 20) or hamstring (HS; n = 20). Participants in each arm were randomized into a control group who underwent standard ACLR or an intervention group who had their grafts wrapped with an amnion collagen matrix during graft preparation, after which BMAC was injected under the wrap layers after implantation. Postoperative magnetic resonance imaging (MRI) mapping/processing yielded mean T2* relaxation time and graft volume values at 3, 6, 9, and 12 months. Participants completed the Single Assessment Numeric Evaluation Score, Knee injury and Osteoarthritis Outcome Score, and pain visual analog scale. Statistical linear mixed-effects models were used to quantify the effects over time and the differences between the control and intervention groups. Adverse events were also recorded., Results: No significant differences were found at any time point between the intervention and control groups for BTB T2* (95% CI, -1.89 to 0.63; P = .31), BTB graft volume (95% CI, -606 to 876.1; P = .71), HS T2* (95% CI, -2.17 to 0.39; P = .162), or HS graft volume (95% CI, -11,141.1 to 351.5; P = .28). No significant differences were observed between the intervention and control groups of either graft type on any patient-reported outcome measure. No adverse events were reported after a 2-year follow-up., Conclusion: In this pilot study, wrapping a graft with an amnion collagen matrix and injecting BMAC appeared safe. MRI T2* values and graft volume of the augmented ACL graft were not significantly different from that of controls, suggesting that the intervention did not result in improved graft maturation., Registration: NCT03294759 (ClinicalTrials.gov identifier)., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: Funding was received from Arthrex (grant US-01087). A.W.A. has received nonconsulting fees from Arthrex, CGG Medical, and Smith & Nephew; consulting fees from Arthrex and Bioventus; education payments from Arthrex, CGG Medical, Bioventus, and Mid-Atlantic Surgical Systems; and royalties from Arthrex. S.E.J. has received royalties from Arthrex; education payments from CGG Medical; nonconsulting fees from Arthrex and CGG Medical; and education payments from Arthrex and CGG Medical. R.V.O. has received education payments and nonconsulting fees from Arthrex; and consulting fees from DePuy Synthes. E.A.B. has received grant support from Arthrex and education payments from Smith & Nephew, MVP Orthopedics, and Arthrex. J.R.A. has received nonconsulting fees from Arthrex. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto. Ethical approval for this study was obtained from Baptist Hospital–Pensacola (ref No. 1017674-1)., (© The Author(s) 2023.)

Objective: This study intended to evaluate a possible therapeutic effect among patients with treatment-refractory generalized anxiety disorder (trGAD) by using transcranial focused ultrasound (tfUS) to modulate amygdalar activity., Methods: Twenty-five participants with severe trGAD as outlined in the DSM-V were recruited from Los Angeles neurology and psychiatry clinics. All participants completed eight weekly 10-min tfUS sessions targeting the right amygdala. Functional and structural neuroimaging were used to navigate individual targets. Outcome measures including the Hamilton Anxiety Inventory (HAM-A, primary outcome) and Beck Anxiety Inventory (BAI) were collected at baseline and protocol completion. Upon study completion, participants were asked to report perceived change in clinical status using the Patient Global Impression - Improvement (PGI-I) scale. Data was collected from May 2020 through January 2023., Results: All participants were able to tolerate treatment without notable side effects. No adverse events were reported. A Wilcoxon Signed-Rank Test was conducted to compare pre- and post-tfUS measures of anxiety. tfUS resulted in a significant decrease in anxiety as measured by the HAM-A (W = -3.69, p < 0.001, pre-post-Δ = -12.64 ± 12.51) and the BAI (W = -3.94, p < 0.001, pre-post-Δ = -12.88 ± 10.42). Sixteen (16) of twenty-five (25) total participants indicated clinically significant benefit on PGI-I scores at completion., Conclusion: This study provides preliminary evidence supporting the safety and efficacy of tfUS as a clinical intervention. These results warrant further investigation of tfUS as a therapeutic intervention for anxiety and other psychiatric and neurological disorders., Gov Identifier: NCT04250441., Competing Interests: Declaration of competing interest Author Alexander Bystritsky, MD, PhD, is the CEO of Brainsonix Corp., the manufacturer of the Brainsonix Pulsar 1002 device. Author Norman Spivak is a consultant for the BrainSonix Corp. Taylor Kuhn, PhD, is a consultant and is a shareholder of Sanmai Technologies, PBC. The remaining authors report no conflicts of interest., (Copyright © 2023. Published by Elsevier Ltd.)

The rotator cable is an essential biomechanical structure in the shoulder that is commonly injured in the setting of large rotator cuff tears. Surgical techniques designed to reconstruct the cable have followed advancements in our understanding of the biomechanics and anatomic importance of this structure. Owing to its role in load sharing and stress shielding of the rotator cuff crescent, rotator cable reconstruction offers the potential to reduce retear rates and promote longevity of rotator cuff repairs. The purpose of this article is to describe a technique to augment rotator cuff repair with cable reconstruction., (© 2023 The Authors.)

Introduction: This study intended to evaluate the safety and possible therapeutic effect of transcranial infrared laser stimulation (TILS) based on photobiomodulation (PBM) among patients with traumatic brain injury (TBI). Methods: Eleven participants who were diagnosed with TBI after full neurological examination and MRI evaluation by a board-certified neurologist completed five to eight 20-minute TILS sessions using the Cytonsys CytonPro-5000 apparatus (pilot laser control, focused wavelength of 1064 nm, maximum output power of 10W, maximum optical power density of 500 mW/cm 2 , effective area 4.5 cm 2 in diameter). Per TILS session, participants underwent a laser dose of 250 mW/cm 2 continuous laser wave to each hemisphere using predetermined patient-specific coordinates. Structural imaging was used to neuronavigate individual treatment targets in the frontal cortex (Brodmann area 10). The primary safety measure for this study was the occurrence of adverse events (AEs) or serious adverse events (SAEs). The primary efficacy outcome measure was the participant-rated global rating of change (GRC) post-intervention. Secondary outcome measures included a battery of neuropsychological testing and mood questionnaires done both pre- and post-intervention. Results: All patients enrolled in this study protocol were able to tolerate the study procedures without any AEs or SAEs. Nine out of eleven participants had clinically significant improvements in GRC score (≥ +2). Neuropsychological testing and mood questionnaire outcomes also suggested a positive therapeutic effect. Conclusion: This study provides preliminary evidence supporting the safety and potential efficacy of TILS as a non-invasive clinical intervention for individuals with TBI., Competing Interests: We have no conflict of interest to disclose., (Copyright © 2022 J Lasers Med Sci.)

Livestock grazing is a globally important land use and has the potential to significantly influence plant community structure and ecosystem function, yet several critical knowledge gaps remain on the direction and magnitude of grazing impacts. Furthermore, much of our understanding of the long-term effects on plant community composition and structure are based on grazer exclusion experiments, which explicitly avoid characterizing effects along grazing intensity gradients. We sampled big sagebrush plant communities using 68 plots located along grazing intensity gradients to determine how grazing intensity influences multiple aspects of plant community structure over time. This was accomplished by sampling plant communities at different distances from 17 artificial watering sources, using distance from water and cow dung density as proxies for grazing intensity at individual plots. Total vegetation cover and total grass cover were negatively related to grazing intensity, and cover of annual forbs, exotic cover, and exotic richness were positively related to grazing intensity. In contrast, species richness and composition, bunchgrass biomass, shrub density and size, percentage cover of bare ground, litter, and biological soil crusts did not vary along our grazing intensity gradients, in spite of our expectations to the contrary. Our results suggest that the effects of livestock grazing over multiple decades (mean = 46 years) in our sites are relatively small, especially for native perennial species, and that the big sagebrush plant communities we sampled are somewhat resistant to livestock grazing. Collectively, our findings are consistent with existing evidence that indicates the stability of the big sagebrush plant functional type composition under current grazing management regimes., (© 2022 The Ecological Society of America.)

Objective: Delay in initiating cervical cancer treatment may impact outcomes. In a cohort of patients initially treated by surgery, chemoradiation, chemotherapy, or in a clinical trial, we aim to define factors contributing to prolonged time to treatment initiation., Methods: Data from patients initiating treatment for cervical cancer at a single institution was abstracted. Time to treatment initiation was defined as the interval from the date of cancer diagnosis to the date of treatment initiation. Poisson regression model was used for analysis., Results: Of 274 patients studied, the median time to treatment initiation was 60 days (range 0-551). The median times to initiate surgery (54 days, range 3-96) and chemoradiation (58 days, range 4-187) were not significantly different (relative risk (RR) 1.01, 95% CI 0.98 to 1.04, p=0.54). The shortest median initiation time was for chemotherapy (47 days; RR 1.13, 95% CI 1.08 to 1.19, p<0.0001) and the longest was for clinical trial (62 days; RR 1.18, 95% CI 1.12 to 1.24, p<0.0001). Charity care (RR 1.09, 95% CI 1.05 to 1.14, p<0.0001), Medicare or Medicaid (RR 1.10, 95% CI 1.06 to 1.14, p<0.0001), and self-pay (RR 1.38, 95% CI 1.32 to 1.45, p<0.0001) delayed treatment initiation more than private insurance. Hispanic White women (RR 0.69, 95% CI 0.66 to 0.73, p<0.0001) had a shorter treatment initiation time compared with non-Hispanic White patients, while Afro-Caribbean/Afro-Latina women (RR 0.86, 95% CI 0.81 to 0.90, p<0.0001) and African-American patients (RR 1.13, 95% CI 1.07 to 1.19, p<0.0001) had longer initiation times. Spanish speaking patients did not have a prolonged treatment initiation (RR 0.68, 95% CI 0.66 to 0.71, p<0.0001), though Haitian-Creole speaking patients did (RR 1.07, 95% CI 1.01 to 1.13, p<0.002). Diagnosis at an outside institution delayed treatment initiation time (RR 1.24, 95% CI 1.18 to 1.30, p<0.0001) compared with diagnosis at the cancer center., Conclusion: Factors associated with prolonged time to treatment initiation include treatment modality, insurance status, language spoken, and institution of diagnosis. By closely examining each of these factors, barriers to treatment can be identified and modified to shorten treatment initiation time., Competing Interests: Competing interests: None declared., (© IGCS and ESGO 2022. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.)

Quadriceps tendon ruptures compromise the knee extensor mechanism and cause an inability to ambulate and significant functional limitations. Therefore, the vast majority of quadriceps tendon ruptures are indicated for operative intervention to restore patient mobility and function. Although these injuries were traditionally repaired using a transosseous repair technique, recent literature has shown that suture anchor repair may offer biomechanical advantages. Additionally, research in other areas of orthopaedics has found that a double-row suture anchor construct can offer additional biomechanical strength to tendinous repair. This technical note describes a safe and effective quadriceps tendon repair using a double-row suture anchor construct., (© 2021 Published by Elsevier on behalf of the Arthroscopy Association of North America.)

Background: This study sought to validate the clinical utility of multimodal magnetic resonance imaging (MRI) techniques in the assessment of neurodegenerative disorders. We intended to demonstrate that advanced neuroimaging techniques commonly used in research can effectively be employed in clinical practice to accurately differentiate heathy aging and dementia subtypes., Methods: Twenty patients with dementia of the Alzheimer's type (DAT) and 18 patients with Parkinson's disease dementia (PDD) were identified using gold-standard techniques. Twenty-three healthy, age and sex matched control participants were also recruited. All participants underwent multimodal MRI including T1 structural, diffusion tensor imaging (DTI), arterial spin labeling (ASL), and magnetic resonance spectroscopy (MRS). MRI modalities were evaluated by trained neuroimaging readers and were separately assessed using cross-validated, iterative discriminant function analyses with subsequent feature reduction techniques. In this way, each modality was evaluated for its ability to differentiate patients with dementia from healthy controls as well as to differentiate dementia subtypes., Results: Following individual and group feature reduction, each of the multimodal MRI metrics except MRS successfully differentiated healthy aging from dementia and also demonstrated distinct dementia subtypes. Using the following ten metrics, excellent separation (95.5% accuracy, 92.3% sensitivity; 100.0% specificity) was achieved between healthy aging and neurodegenerative conditions: volume of the left frontal pole, left occipital pole, right posterior superior temporal gyrus, left posterior cingulate gyrus, right planum temporale; perfusion of the left hippocampus and left occipital lobe; fractional anisotropy (FA) of the forceps major and bilateral anterior thalamic radiation. Using volume of the left frontal pole, right posterior superior temporal gyrus, left posterior cingulate gyrus, perfusion of the left hippocampus and left occipital lobe; FA of the forceps major and bilateral anterior thalamic radiation, neurodegenerative subtypes were accurately differentiated as well (87.8% accuracy, 95.2% sensitivity; 85.0% specificity)., Conclusions: Regional volumetrics, DTI metrics, and ASL successfully differentiated dementia patients from controls with sufficient sensitivity to differentiate dementia subtypes. Similarly, feature reduction results suggest that advanced analyses can meaningfully identify brain regions with the most positive predictive value and discriminant validity. Together, these advanced neuroimaging techniques can contribute significantly to diagnosis and treatment planning for individual patients., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/qims-20-1355). Author SEJ, MD is the owner of Synaptec Network, an MRI software analytics company. Authors SB and TK, PhD. are both part-time employees of Synaptec Network. The other authors have no conflicts of interest to declare., (2021 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Objective: Transcranial Focused Ultrasound (tFUS) is a promising new potential neuromodulation tool. However, the safety of tFUS neuromodulation has not yet been assessed adequately. Patients with refractory temporal lobe epilepsy electing to undergo an anterior temporal lobe resection present a unique opportunity to evaluate the safety and efficacy of tFUS neuromodulation. Histological changes in tissue after tFUS can be examined after surgical resection, while further potential safety concerns can be assessed using neuropsychological testing., Methods: Neuropsychological functions were assessed in eight patients before and after focused ultrasound sonication of the temporal lobe at intensities up to 5760 mW/cm 2 . Using the BrainSonix Pulsar 1002, tFUS was delivered under MR guidance, using the Siemens Magnetom 3T Prisma scanner. Neuropsychological changes were assessed using various batteries. Histological changes were assessed using hematoxylin and eosin staining, among others., Results: With respect to safety, the histological analysis did not reveal any detectable damage to the tissue, except for one subject for whom the histology findings were inconclusive. In addition, neuropsychological testing did not show any statistically significant changes in any test, except for a slight decrease in performance on one of the tests after tFUS., Significance: This study supports the hypothesis that low-intensity Transcranial Focused Ultrasound (tFUS) used for neuromodulation of brain circuits at intensities up to 5760 mW/cm 2 may be safe for use in human research. However, due to methodological limitations in this study and inconclusive findings, more work is warranted to establish the safety. Future directions include greater number of sonications as well as longer exposure at higher intensity levels to further assess the safety of tFUS for modulation of neuronal circuits., Competing Interests: Declaration of competing interest Dr. Korb is a Vice-President of BrainSonix Inc. Dr. Schafer is the Chief Technology Officer of BrainSonix Inc. Dr. Bystritsky is the Founder and Chief Executive Officer of BrainSonix Inc. Drs. Korb, Schafer, Bystritsky also own shares in the company. Other authors report no conflicts of interest., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Anxiety Disorders are prevalent and often chronic, recurrent conditions that reduce quality of life. The first-line treatments, such as serotonin reuptake inhibitors and cognitive behavioral therapy, leave a significant proportion of patients symptomatic. As psychiatry moves toward targeted circuit-based treatments, there is a need for a theory that unites the phenomenology of anxiety with its underlying neural circuits. The Alarm, Belief, Coping (ABC) theory of anxiety describes how the neural circuits associated with anxiety interact with each other and domains of the anxiety symptoms, both temporally and spatially. The latest advancements in neuroimaging techniques offer the ability to assess these circuits in vivo. Using Neurosynth, a large open-access meta-analytic imaging database, the association between terms related to specific neural circuits was explored within the ABC theory framework. Alarm-related terms were associated with the amygdala, anterior cingulum, insula, and bed nucleus of stria terminalis. Belief-related terms were associated with medial prefrontal cortex, precuneus, bilateral temporal poles, and hippocampus. Coping-related terms were associated with the ventrolateral and dorsolateral prefrontal cortices, basal ganglia, and anterior cingulate. Neural connections underlying the functional neuroanatomy of the ABC model were observed. Additionally, there was considerable interaction and overlap between circuits associated with the symptom domains. Further neuroimaging research is needed to explore the dynamic interaction between the functional domains of the ABC theory. This will pave the way for probing the neuroanatomical underpinnings of anxiety disorders and provide an evidence-based foundation for the development of targeted treatments, such as neuromodulation., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: The pursuit of an effective therapeutic intervention for dementia has inspired interest in the class of medications known as tyrosine kinase inhibitors such as bosutinib., Methods: Thirty-one patients with probable Alzheimer dementia or Parkinson spectrum disorder with dementia completed 12 months of bosutinib therapy and an additional 12 months of follow-up. The Clinical Dementia Rating scale (as estimated by the Quick Dementia Rating System [QDRS]) was the primary cognitive status outcome measure. Secondary outcome measures included the Repeatable Battery Assessment of Neuropsychological Status (RBANS) and the Montreal Cognitive Assessment. Cox regression methods were used to compare results with population-based estimates of cognitive decline., Results: The present article reports on cognitive outcomes obtained at 12 months for 31 participants and up to 24 months for a 16-participant subset. Safety and tolerability of bosutinib were confirmed among the study population (M age = 73.7 years, SD age = 14 years). Bosutinib was associated with less worsening in Clinical Dementia Rating (CDR) scores (hazard ratio = -0.62, p < 0.001, 95% confidence interval [CI]: -1.02 to -0.30) and less decline in RBANS performance (hazard ratio = -3.42, p < 0.001, 95% CI: -3.59 to -3.72) during the year of treatment than population-based estimates of decline. In the 24-month follow-up, wherein 16 patients were observed after 1 year postintervention, 31.2% of participants exhibited worsened CDR levels compared with their 12-month performances., Conclusions: Results support an overall positive outcome after 1 year of bosutinib. Future studies should explore the relationship between tyrosine kinases and neurodegenerative pathology as well as related avenues of treatment., (© 2021 American Academy of Neurology.)