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Complex bidirectional crosstalk between adipocytes and adipose tissue immune cells plays an important role in regulating adipose function, inflammation, and insulin responsiveness. Adipocytes secrete the pleiotropic cytokine IL-6 in response to both inflammatory and catabolic stimuli. Previous studies suggest that IL-6 secretion from adipocytes in obesity may promote adipose tissue inflammation. Here we investigated catabolic stimulation of adipocyte IL-6 secretion and its impact on adipose tissue immune cells. In obesity, catecholamine resistance reduces cAMP-driven adipocyte IL-6 secretion in response to catabolic signals. By restoring adipocyte catecholamine sensitivity in obese adipocytes, amlexanox stimulates adipocyte-specific IL-6 secretion. Here we report that in this context, adipocyte secreted IL-6 activates local macrophage STAT3 to promoteIl4raexpression, thereby sensitizing them to IL-4 signaling, and promoting an anti-inflammatory gene expression pattern. Supporting a paracrine adipocyte to macrophage mechanism, these effects could be recapitulated using adipocyte conditioned media to pretreat bone marrow derived macrophages prior to polarization with IL-4. The effects of IL-6 signaling in the adipose tissue are complex and context specific. These results suggest that cAMP driven IL-6 secretion from adipocytes sensitizes adipose tissue macrophages to IL-4 signaling.

The kelp Lessonia corrugata (Ochrophyta, Laminariales) is being developed for integrated multi-trophic aquaculture (IMTA) trials in the vicinity of salmon cages in Tasmania, Australia. Gametophytes are vegetally maintained before seeding on hatchery twine; however, the optimal temperature and light conditions for growth and sexual development are unknown. We measured vegetative size of female and male gametophytes and sexual development of females over a range of temperatures and irradiances using a temperature gradient table and neutral density light filters. Over a 4-week experiment, gametophytes were exposed to a combination of thermal (5.7–24.9 °C) and irradiance (10–100 μmol photons m−2 s−1) gradients, to assess biological performance. At the temperature extremes (hottest = 24.9 °C, coldest = 5.7 °C), we observed the critical thermal limits for this species and the results reveal a narrow optimal temperature range for growth and sexual development between 15.7 and 17.9 °C, with irradiances between 40 and 100 μmol photons m−2 s−1 resulting in fertile female gametophytes. Lessonia corrugata inhabits a small geographic range, found only around Tasmania, south of the Australian mainland, hence oceanic changes such as ongoing increases in sea surface temperatures (SSTs), and altered irradiance regimes may limit recruitment of the early microscopic life stages in the future. Our findings provide optimised culture conditions for aquaculture and information to predict the future geographic range of L. corrugata under ocean global change.

Arthroscopic procedures are used to treat a multitude of disorders, but they can be technically demanding. These procedures are a fundamental aspect of orthopaedic surgery residency and surgical sports medicine fellowship. The goal of this study was to analyze the variability in arthroscopic case experience to better understand the disparities between various training programs and the opportunity for increased surgical case volume of an orthopaedic sports medicine fellowship. Resident and fellow case log reports were gathered from the Accreditation Council for Graduate Medical Education. Fellows reported 286% more arthroscopic cases in one year of fellowship than residents reported in five years of residency (554 cases vs. 193 cases, p0.0001). Fellows also performed 770% more arthroscopic hip procedures than residents (57 cases vs. 7 cases, p0.0001). There is a significant difference in arthroscopic case volume between residents and fellows. An orthopaedic sports medicine fellowship dramatically increases the arthroscopic experience of trainees. (Journal of Surgical Orthopaedic Advances 31(1):022-025, 2022).

Objectives: To evaluate the effect of blood flow restriction (BFR) therapy conducted before and after rotator cuff repair (RCR) on rotator cuff strength and patient reported outcomes. Methods: A total of 30 patients (22 male, 8 female; age 58.2 ± 9.0 years) presenting for surgical treatment of a rotator cuff tear were randomized into two groups, BFR (N=15) and Control (N=15). Rotator cuff strength was measured utilizing a handheld dynamometer in order to calculate peak force, average force and time to peak force. Strength measurements included supraspinatus, infraspinatus and subscapularis testing in multiple positions. Prior to surgery, patients completed a rotator cuff strengthening program, with and without the use of BFR. All patients underwent arthroscopic RCR and a standardized period of post-operative immobilization. Following surgery, patients underwent physical therapy utilizing standard post-RCR therapy protocols, with exercises performed with and without the use of BFR in each respective group. The BFR group was instructed to perform these exercises with a pneumatic cuff set to 80% of limb occlusion pressure placed over the proximal arm, under the direction of a physical therapist. Patient Reported Outcome Measurement System Upper Extremity (PROMIS-UE), American Shoulder and Elbow Surgeons (ASES) score and shoulder range of motion were collected on the day of surgery as well as 2 weeks, 6 weeks and 3 months after surgery. Rotator cuff strength measurements were completed the day of surgery and repeated three months following RCR. Results: No significant differences were noted between the BFR and control groups in peak rotator cuff muscle force generation, time to peak force or average force at any timepoints (P>0.05). At six weeks post-surgery, the BFR group had significantly higher PROMIS-UE scores (30.3 ± 4.7 versus 26.3 ± 6.3, p=0.03, Figure 1) and active range of motion in abduction (82.4º ± 24.7 versus 65.1º ± 18.8, p=0.03) compared to the control group. These differences were not apparent at 3 month follow up. Conclusions: Blood flow restriction therapy following RCR results in improved patient reported outcomes scores and range of motion at six week follow up. At three months post-surgery, there was no noted improvement in rotator cuff strength when utilizing BFR compared to standard physical therapy.

Objectives: To investigate the impact of arthroscopic shoulder labral repair on return to play (RTP), career longevity, workload, and performance of Major League Baseball (MLB) athletes Methods: A retrospective review of MLB players after arthroscopic shoulder labral repair from 2004-2018 was performed. A 2:1 control group matched by demographic information was used. Demographics, workload, and performance metrics were collected. Statistical analysis examined workload/performance at one and three-years after injury compared to one-year before. Workload/performance percentage relative to baseline was also compared. Results: 26/ 39 (66%) pitchers and 18/25 (72%) positional players RTP and were matched with 54 and 34 controls, respectively. Following surgery, players experienced shorter careers (2.3 ± 2.6 vs 5.8 ± 2.8, pConclusions: Following RTP after arthroscopic shoulder labral repair, MLB players had reduced career longevity and workload/performance one-year post-index, but these stats returned towards baseline at three-years post-index. [Figure: see text][Figure: see text][Table: see text][Table: see text]

Objectives: To examine the current body of research and determine whether there is an increased risk for LE musculoskeletal injury following a concussion and identify populations at an increased risk. Methods: A systematic review of the literature from January 1, 2000 to September 30, 2020 was performed using MEDLINE and PubMed databases. Key words included concussion, athlete, lower extremity injury, and return to sport. Inclusion criteria required original research articles written in English language examining the rate of LE injuries following a diagnosed concussion. Data extracted from each study included number of subjects, age, sex, sport played, level of play, odds ratio (OR) of injury, and number of concussions per athlete. Results: A total of 13 studies involving 4,349 athletes (88.1% male; mean age 19.8 years) met inclusion criteria. Athletes were classified as either high school (46.1%), collegiate (17.0%), or professional (36.9%). Four studies demonstrated an increased risk of LE injury within 90 days of a diagnosed concussion (OR 3.44, 95% CI 2.99-4.42) and 7 studies revealed an elevated risk of injury within one year of concussion (OR 1.85, 95% CI 1.73-2.84). Professional and college athletes demonstrated an increased risk (OR 2.49, 95% CI 2.40-2.72; OR 2.00, 95% CI 1.96-2.16, respectively) compared to high school athletes (OR 0.97, 95% CI 0.89-1.05). A stepwise increase in risk of sustaining a LE injury was observed with multiple concussions, with increasing risk observed from 2+ (OR 2.29, 95% CI 1.85-2.83) to 3+ career concussions (OR 2.86, 95% CI 2.36-3.48). Conclusions: An increased incidence of LE injuries was observed at 90-days and one year following the diagnosis of a concussion. Higher levels of competition, such as at the collegiate and professional level, resulted in an increased risk of sustaining a subsequent LE injury following a diagnosed concussion. These results suggest an at-risk population which may benefit from injury prevention methods following a concussion. [Table: see text][Table: see text][Table: see text][Table: see text]

Objectives: To identify predictive factors for continued opioid prescriptions after arthroscopic meniscal resection or repair and develop a predictive machine learning model. Methods: Patients undergoing arthroscopic meniscal surgery between August 2013 and February 2017 at a single institution were retrospectively identified. Patient demographic variables were recorded including age, sex, body mass index, and history of chronic opioid usage (> 1 month). Procedural details were recorded such as concomitant procedures, primary versus revision, and whether a partial debridement or a repair was performed. Intraoperative arthritis severity was measured using the Outerbridge Classification. Types of opioid medications prescribed and in which months were documented. For primary analysis, we used a multivariate Cox-Regression model. We then created a naïve Bayesian model, a machine learning classifier that utilizes Bayes’ theorem with an assumption of independence between the variables collected. The model randomly selected 70% of the sample to be trained on while 30% were tested. Results: A total of 735 patient were reviewed. Postoperative opioid refills occurred in 98 patients (16.9%). Using multivariate logistic modeling, independent risk factors for opioid refills included Male sex, larger BMI, chronic preoperative opioid use while meniscus resection demonstrated decreased likelihood of refills. Concomitant procedures, revisions, and presence of arthritis graded by the Outerbridge classification were not significant predictors of opioid refills. The Naïve Bayesian model for extended postoperative opioid use demonstrated good fit with our cohort with an area under the curve of 0.79, sensitivity of 94.5%, PPV of 83%, and a detection rate of 78.2%. Conclusions: After arthroscopic meniscus surgery, preoperative opioid consumption had the strongest association with sustained opioid use >1 month. Intraoperative arthritis was not an independent risk factor for continued refills. A novel machine learning algorithm performed with high accuracy and predictive ability to identify patients filling additional narcotic prescriptions after surgery. [Figure: see text][Table: see text]

Objectives: It is still unclear which patients benefit from nonoperative treatment of rotator cuff tear versus those who benefit from early intervention. The purpose of our study was to determine which patients benefit from conservative therapy and establish the MCID of patients undergoing nonoperative treatment for partial and full-thickness rotator cuff tears (RCT). Methods: We performed a retrospective cohort study evaluating non-operatively managed patients with MRI-confirmed partial-thickness and full-thickness RCT (PTRCT, FTRCT). We included patients who underwent initial course consisting of rest, activity modification, physical therapy, and/or injection for their condition. In our institution, all patients complete National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) assessments for physical function and pain interference. In patients with shoulder conditions, this consists of the PROMIS Upper Extremity Computer Adaptive Test (CAT) v2.0 (“PROMIS UE”) and the PROMIS Pain Interference CAT v1.1 (“PROMIS PI”). Treatment modalities and follow-up PROMIS scores at least 6 weeks after initial visit were recorded. Using a distribution technique, the minimum clinically important difference (MCID) was calculated, and the proportion of patients achieving MCID for each tear group for both function and pain was determined. Chi-square tests were used to compare MCID achievement between PTRCT and FTRCT patients for both PROMIS UE and PROMIS PI. Results: A total of 100 FTRCT and 90 PTRCT patients were included in this analysis. Average age was 61.2 years, with 59% (n=112) female patients. The MCID for PROMIS UE was determined to be 3.9 and 3.9 for PTRCT and FTRCT patients, respectively. For PROMIS PI, MCID was 3.1 and 3.7 for PTRCT and FTRCT, respectively. In patients with PTRCT, the baseline score improved slightly from 31.4 to 34.9 for PROMIS UE, compared to a score change of 30.1 to 32.8 for patients with FTRCT. In total, 46% of PTRCT and 38% of FTRCT achieved MCID for PROMIS UE. In patients with PTRCT, the baseline score improved slightly from 63.1 to 60.0 for PROMIS PI, compared to a score change of 63.4 to 61.1 for patients with FTRCT. In total, 33% of PTRCT and 36% of FTRCT achieved MCID for PROMIS PI. When comparing PROMIS UE scores between PTRCT and FTRCT patients, there was no statistically significant difference in achievement of MCID (p=0.288). This was also the case for PROMIS PI (p=0.727). Conclusions: The present study identified MCID for PROMIS UE and PROMIS PI in both PTRCT and FTRCT undergoing conservative management. Only a minority of patients achieved MCID for pain (33% for PTRCT and 36% for FTRCT). A slightly higher proportion of patients achieved MCID for physical function (46% for PTRCT and 38% for FTRCT). The results of this study indicate that, while function may be more likely improved than pain, neither domains are significantly improved following initial nonoperative management in this patient population.

Background and Aims: Intraoperative neurophysiological monitoring (IONM) is the standard of care during many spinal, vascular, and intracranial surgeries. High-quality perioperative care requires the communication and cooperation of several multidisciplinary teams. One of these multidisciplinary services is intraoperative neuromonitoring (IONM), while other teams represent anesthesia and surgery. Few studies have investigated the IONM team's objective communication with anesthesia providers. We conducted a retrospective review of IONM-related quality assurance data to identify how changes in the evoked potentials observed during the surgery were communicated within our IONM-anesthesia team and determined the resulting qualitative outcomes. Material and Methods: Quality assurance records of 3,112 patients who underwent surgical procedures with IONM (from 2010 to 2015) were reviewed. We examined communications regarding perioperative evoked potential or electroencephalography (EEG) fluctuations that prompted neurophysiologists to alert/notify the anesthesia team to consider alteration of anesthetic depth/drug regimen or patient positioning and analyzed the outcomes of these interventions. Results: Of the total of 1280 (41.13%) communications issued, there were 347 notifications and 11 alerts made by the neurophysiologist to the anesthesia team for various types of neuro/orthopedic surgeries. Prompt communication led to resolution of 90% of alerts and 80% of notifications after corrective measures were executed by the anesthesiologists. Notifications mainly related to limb malpositioning and extravasation of intravenous fluid. Conclusion: Based on our institutions' protocol and algorithm for intervention during IONM-supported surgeries, our findings of resolution in alerts and notifications indicate that successful communications between the two teams could potentially lead to improved anesthetic care and patient safety.

Introduction Patients with spinal muscular atrophy are a difficult population for neurophysiological monitoring. In our retrospective study, we attempt to study the characteristics of the evoked potentials and their physiognomies in three types of phenotypes, which present for surgical correction of their spine deformity. Methods A retrospective IONM database review was accomplished for ten patients who underwent 35 surgeries at our institution from August 2010 till March 2015. TcMEPs, SSEPs, free running EMG, EEG, and TOF, were recorded in all cases after the patients were anesthetized. Recordings were measure before and after positioning and throughout the surgical procedure. Results In the patients identified, intraoperative monitoring records were analyzed for characteristics of IONM modalities commonly used. In 34 (97.14%) surgeries, patients had obtainable and reproducible upper SSEPs. Lower limb SSEPs were present and were within normal range in 17 (48.57%) procedures. In eight cases (13%), no reliable monitoring could be achieved and was therefore abandoned. Right brevis TcMEPs was absent in one (2.84%), while it was obtained in all other cases. While potentials from hallicus and tibialis anterior were absent in only seven cases (20%). Throughout the surgery, there was no statistically significant variation in the depth of anesthesia as measured by the spectral index of the EEG (p = 0.4849). Conclusion We conclude that SSEPs and TcMEPs are obtainable and could be combined with other routine IONM modalities to monitor SMA patients undergoing spine corrective surgeries. The presence of upper extremity SSEP and TcMEPs enable perioperative monitoring to mitigate any impending neurological injuries, especially to the brachial plexus.

Introduction Intraoperative neurophysiological monitoring (IONM) is the standard of care during many spinal, vascular, and intracranial surgeries. High quality perioperative care requires the communication and cooperation of several multidisciplinary teams. One of these multidisciplinary services is intraoperative neuromonitoring (IONM), while other teams represent anesthesia, and surgery. Few studies relate to IONM team’s objective communication with the anesthesia providers. We accomplished a retrospective review of IONM related quality assurance data to identify how changes evoked potentials observed during the surgery were communicated within our IONM-anesthesia team and determined the resulting qualitative outcomes. Methods Quality assurance records of 3112 patients who underwent surgical procedures with IONM (from 2010 to 2015) were reviewed. We examined communications regarding perioperative evoked potential or EEG fluctuations that prompted neurophysiologists to alert/notify anesthesia team to consider alteration of anesthetic depth/drug regimen or patient positioning and analyzed the outcomes of these interventions. Results Of the 1280 (41.13%) total communications issued, there were 347 notifications and 11 alerts made by neurophysiologist to the anesthesia team for various types of neuro/orthopedic surgeries. Prompt communication led to resolution of 90% of alerts and 80% of notifications after corrective measures were executed by the anesthesiologists. Notifications mainly related to limb mal-positioning and extravasation of intravenous fluid. Conclusion Based our institutions’ protocol and algorithm for intervention during IONM-supported surgeries, our findings of resolution in alerts and notifications indicate that successful communications between the two teams could potentially lead to improved anesthetic care and patient safety.

Contributions to the literature on intraoperative neuro monitoring (IONM) during endocrine and head and neck surgery have increased over recent years. Organizational support for neural monitoring during surgery is becoming evident and is increasingly recognized as an adjunct to visual nerve identification. A comprehensive understanding of the role of IONM for prevention of nerve injuries is critical to maximize safety during surgery of the anterior compartment of the neck. This review will explore the potential advantages of IONM to improve the outcomes among patients undergoing anterior neck surgery.

Case Brachial plexopathy is a rare complication of nonoperatively treated clavicular fractures. We describe a 68-year-old man who presented with fracture-callus-induced acute brachial plexopathy and dynamic thoracic outlet syndrome after 9 weeks of nonoperative management for a clavicular fracture. He underwent fracture fixation with brachial plexus decompression via callus excision; intraoperative neuromonitoring was used to evaluate brachial plexus function. Postsurgery, his neurologic function recovered completely. Conclusion Intraoperative neuromonitoring is a useful tool for minimizing the risk of additional brachial plexus injury and determining the adequacy of neural decompression during delayed open reduction and internal fixation of clavicular fractures with fracture-callus-induced brachial plexus compression.