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Background: Shoulder arthroplasty (SA) has been shown to improve quality of life, though outcomes may vary between individuals. Multiple factors may affect outcomes, including preoperative mental health conditions (MHCs). The goal of this systematic review was to evaluate the clinical and functional outcomes after SA in patients with MHC compared to patients without MHC. Methods: This systematic review was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines outlined by Cochrane Collaboration. A search of PubMed, the Medline Library, and EMBASE was conducted from inception until September 2023 to obtain studies reporting outcomes after total shoulder arthroplasty and reverse total shoulder arthroplasty in patients with and without MHC. Study characteristics and information on clinical and functional outcomes were collected. All included studies were case-control studies. The methodological quality of the included primary studies was appraised using the methodological index for nonrandomized studies scoring. Results: Eleven articles published between 2016 and 2023 met inclusion criteria. In total, 49,187 patients, 49,289 shoulders, and five different MHC were included. 8134 patients in the cohort had a diagnosed MHC. The mean patient age was 67.8 years (range, 63.5-71.6 years), and 52.6% of the patients were female. The mean follow-up time was 35.5 months (range, 16.2-58.3 months). Reverse total shoulder arthroplasty was the most common type of procedure (25,543 shoulders, 51.8%). Depression and anxiety were the most reported psychiatric diagnoses (7990 patients, 98.2%). Patients with versus without MHC reported mean improvements of 38 and 42 in American Shoulder and Elbow Surgeons shoulder score and mean Visual Analog Scale pain improvements of 4.7 and 4.9, respectively. Mean complication rates of 31.4% and 14.2% were observed in patients with versus without MHC, respectively. The most prevalent surgical complication in patients with MHC was infection (1.8%), followed by prosthetic complication (1.7%), and adhesive capsulitis (1.6%). Conclusions: Patients with MHC may have lower preoperative range of motion, worse postoperative shoulder function, and higher postoperative pain levels than patients without MHC. Patients with MHC demonstrated improvements in range of motion and functional outcomes after SA but had higher reported complication and revision rates when compared to patients without MHC. Depression and anxiety were the leading conditions correlated with lower outcomes in patients with MHC after SA. Preoperative physical therapy, mental health counseling, and expectation setting may help these patients reach the maximal achievable benefit from SA.

Background: Proximal tibiofibular joint (PTFJ) injuries are rare injuries, and the optimal treatment is poorly understood. Surgical treatment options for PTFJ instability include reconstruction with allograft, stabilization with an adjustable-ength suspensory fixation device, open reduction and internal fixation with a screw, arthrodesis, and proximal fibular resection. Indications: In acute first-time PTFJ dislocations, nonoperative treatment may be trialed after closed reduction. Operative treatment is indicated for first-time dislocation with concomitant operative injury, an irreducible dislocation, and chronic symptomatic PTFJ instability. Taping or PTFJ injections can be helpful for diagnostic and therapeutic purposes and should be trialed before moving forward with surgical treatment. Technique Description: Multiple PTFJ stabilization and reconstruction techniques have been described for PTFJ instability. This technique describes a stabilization technique utilizing an adjustable-ength suspensory fixation device that is placed through a posterolateral approach to the knee. Results: A prior systematic review of PTFJ injuries found that approximately 59% of patients with a PTFJ dislocation were successfully treated nonoperatively with no symptoms at a mean final follow-up of 15.9 months. While multiple case reports and techniques have been reported for PTFJ stabilization using an adjustable-ength suspensory fixation device, there are limited data on outcomes of this procedure. Discussion/Conclusions: PTFJ stabilization using an adjustable-ength suspensory fixation device is a safe and technically feasible option for the treatment of PTFJ instability. It is critical to confirm the diagnosis of symptomatic PTFJ instability with either a taping trial or a diagnostic injection before proceeding with surgical treatment. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Triply Periodic Minimal Surfaces (TPMS), such as Gyroid, are widely accepted for bone tissue engineering due to their interconnected porous structures with tunable properties that enable high surface area to volume ratios, energy absorption, and relative strength. Among these topologies, the Fischer-Koch-S (FKS) has also been suggested for compact bone scaffolds, but few studies have investigated these structures beyond computer simulations. FKS scaffolds have been fabricated in metal and polymer, but to date none have been fabricated in a ceramic used in bone tissue engineering (BTE) scaffolds. This study is the first to fabricate ceramic FKS scaffolds and compare them with the more common Gyroid topology. Results showed that FKS scaffolds were 32% stronger, absorbed 49% more energy, and had only 11% lower permeability than Gyroid scaffolds when manufactured at high porosity (70%). Both FKS and Gyroid scaffolds displayed strength and permeability in the low range of trabecular long bones with high reliability (Weibull failure probability) in the normal direction. Fracture modes were further investigated to explicate the quasi-brittle failure exhibited by both scaffold topologies, exploring stress-strain relationships along with scanning electron microscopy for failure analysis. Considering the physical aspects of successful bone tissue engineering scaffolds, FKS scaffolds appear to be more promising for further study as bone regeneration scaffolds than Gyroid due to their higher compressive strength and reliability, at only a small penalty to permeability. In the context of BTE, FKS scaffolds may be better suited than Gyroids to applications where denser bone and strength is prioritized over permeability, as suggested by earlier simulation studies.

Isolated distal rectus femoris avulsions from the common quadriceps tendon are rare and may be missed due to the integrity of the remaining extensor mechanism. In healthy, active patients, surgical repair is recommended due to the potential for persistent pain, cramping, and weakness. In the case of isolated distal rectus femoris avulsions, however, there are important surgical considerations and differences when compared with the treatment of complete quadriceps tendon ruptures. This Technical Note describes an open repair of an isolated distal rectus femoris rupture with reinsertion into the common quadriceps tendon.

Background The purpose of this study was to evaluate the effect of concomitant open distal clavicle excision (DCE) on postoperative clinical outcomes and incidence of acromial and scapular stress fractures (ASFs) in patients with symptomatic acromioclavicular joint osteoarthritis (ACJ OA) undergoing reverse total shoulder arthroplasty (RTSA). Methods A single-surgeon retrospective cohort study was conducted including patients who underwent primary elective RTSA with or without DCE from 2015 to 2019 with a minimum 6-month follow-up period. Shoulder active range of motion (AROM) and visual analog scale (VAS) pain were recorded preoperatively and postoperatively. ASFs and other adverse events were identified using postoperative notes and/or radiographs. Characteristics and outcomes were compared between the RTSA and RTSA-DCE groups. Results Forty-six RTSA patients (mean age, 67.9±8.7 years; 60.9% male; mean follow-up, 24.9±16.6 months) and 70 RTSA-DCE patients (mean age, 70.2±8.9 years; 20.0% male; mean follow-up, 22.7±12.9 months) were included. There were no significant intergroup differences in rates of ASF (RTSA, 0.0% vs. RTSA-DCE, 1.4%; P=1.00), stress reactions (RTSA, 8.7% vs. RTSA-DCE, 11.4%; P=0.76), reoperation, revision, or infection (all P>0.05), or in pre-to-postoperative reduction in VAS pain (P=0.17) at latest follow-up. However, the RTSA-DCE group had greater pre-to-postoperative improvement in flexion AROM (RTSA, 43.7°±38.5° vs. RTSA-DCE, 59.5°±33.4°; P=0.03) and internal rotation (IR) AROM (P=0.02) at latest follow-up. Conclusions Concomitant DCE in RTSA improves shoulder flexion and IR AROM, alleviates shoulder pain, and does not increase the risk of ASFs. Level of evidenceIII.

Tibial-sided posterior cruciate ligament avulsion fractures are challenging injuries that often occur concomitantly in the setting of multiligament knee and other soft-tissue injuries. There is no consensus on the optimal surgical approach or timing of treatment for these injuries. This Technical Note describes the fixation of a displaced posterior cruciate ligament avulsion fracture with concomitant grade 3 medial collateral ligament injuries and bucket-handle lateral meniscus tears using open and arthroscopic techniques. This method allows the surgeon to address multiple pathologies in a single stage, although it requires strategic planning and rehabilitation considerations.

BackgroundThe BYLieve trial (NCT03056755) confirmed efficacy and safety of alpelisib with fulvestrant for hormone receptor-positive (HR+), human epidermal growth factor receptor-2-negative (HER2-), PIK3CA-mutated advanced breast cancer (ABC), after cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) with an aromatase inhibitor (AI) as immediate prior therapy. Further analyses were performed to compare efficacy from BYLieve with effectiveness of standard treatment in the real-world setting.Materials and methodsPatients who progressed on a CDK4/6i plus AI and were treated with alpelisib with fulvestrant in BYLieve were matched with a real-world patient cohort who received standard-of-care from a deidentified clinico-genomics database (CGDB). Primary and secondary endpoints were to compare progression-free survival (PFS), estimated by the Kaplan-Meier method, and the proportion of patients remaining progression-free at 6 months, respectively, between the two cohorts.ResultsA total of 855 patients with PIK3CA-mutant disease who had prior CDK4/6i plus hormone therapy were selected from the CGDB; further matching to 120 patients from BYLieve selected 95 patients without exposure to HER2-targeting agents, clinical study drug, or alpelisib. In unadjusted and postmatching results, primary and secondary endpoints favored treatment with alpelisib with fulvestrant in BYLieve more than standard treatments in the real-world cohort. Postadjustment, median PFS for patients treated with alpelisib in BYLieve was 7.3 versus 3.7 months in the real-world cohort, and 6-month PFS was 54.6% versus 40.1%, respectively.ConclusionMatched/weighted analysis comparing BYLieve with the real-world setting further supports the clinical benefit of alpelisib with fulvestrant for treatment of HR+, HER2-, PIK3CA-mutant ABC after CDK4/6i treatment.Implications for practiceApproximately 40% of patients with hormone receptor-positive (HR+), human epidermal growth factor receptor-2-negative (HER2-) advanced breast cancer (ABC) have PIK3CA-mutated tumors, which have been associated with endocrine therapy resistance. Alpelisib, an α-selective phosphatidylinositol-3-kinase inhibitor, demonstrated significantly improved progression-free survival in SOLAR-1 and demonstrated clinical efficacy in BYLieve when combined with fulvestrant. Data are limited in comparing the efficacy of alpelisib combined with fulvestrant with effectiveness of standard therapy after CDK4/6i treatment. Using real-world data, this is the first analysis comparing alpelisib combined with fulvestrant with standard treatments for HR+, HER2-, PIK3CA-mutant ABC in the post-CDK4/6i setting.

Purpose: To describe a case of tattoo-associated sarcoidosis presenting with cutaneous findings of tattoo granulomas and ophthalmic manifestation of isolated bilateral lacrimal gland enlargement. Observations: A 35-year-old female presented with bilateral upper eyelid swelling for over a year. She reported no associated episodes of ocular pain or visual decline since onset of eyelid edema. On examination, the lacrimal glands were firm and enlarged bilaterally. Slit-lamp examination demonstrated no evidence of active or prior ocular inflammation. Further systemic examination revealed multiple raised papules within a 4-year-old chest/shoulder tattoo. Histopathology from a lacrimal gland biopsy showed non-caseating granulomas consistent with sarcoidosis. Conclusions and importance: The authors report a rare case of a 35-year-old presenting with isolated dacryoadenitis and tattoo granulomas found to be a tattoo-associated sarcoidosis. Although uveitis is a commonly described ocular manifestation in tattoo-associated sarcoidosis, few reports have described lacrimal gland enlargement as a presenting ophthalmic feature in tattoo-associated sarcoidosis.

Abstract Background Carbapenem-resistant (CR) Acinetobacter baumannii is a concerning pathogen in the USA and worldwide. Methods To assess the comparative burden of CR vs carbapenem-susceptible (CS) A. baumannii, this retrospective cohort study analyzed data from adult patients in 250 US hospitals from the Premier HealthCare Database (2014–2019). The outcomes analyzed included hospital length of stay (LOS), intensive care unit (ICU) utilization, discharge status, in-hospital mortality, readmission rates and hospital charges. Logistic regression was used for univariate and multivariable assessment of the independent relationship between relevant covariates, with a focus on CR status, and in-hospital mortality. Results 2047 Patients with CR and 3476 patients with CS A. baumannii infections were included. CR A. baumannii was more commonly isolated in respiratory tract infections (CR 40.7% and CS 27.0%, P

Abstract To assess the repeatability and comparability of the Galilei G4 versus the Cassini topographer in post-refractive eyes and in normal eyes, including older patients representative of an initial cataract evaluation. Simulated keratometric (simK), total corneal and posterior corneal power and astigmatism were evaluated in both post-refractive and normal eyes. Repeatability was measured by calculating within-subject standard deviation (Sw), coefficient of variation (CoV), and intraclass correlation coefficient (ICC). Vector analyses and Bland–Altman plots were employed to assess agreement between devices. We studied 32 subjects with a history of refractive surgery and 32 subjects without a history of refractive surgery undergoing cataract surgery. The mean age was 55 ± 18.5 years and the age range was 21.5–91.5 years. In non-refractive and post-refractive eyes, the ICC was > 0.9 (P

Abstract Background Urinary tract infections (UTIs) are the most common infections caused by Gram-negative bacteria and represent a major healthcare burden. Carbapenem-resistant (CR) strains of Enterobacterales and non-lactose fermenting pathogens further complicate treatment approaches. Methods We conducted a retrospective analysis of the US Premier Healthcare Database (2014–2019) in hospitalised adults with a UTI to estimate the healthcare burden of Gram-negative CR UTIs among patients with or without concurrent bacteraemia. Results Among the 47,496 patients with UTI analysed, CR infections were present in 2076 (4.4%). Bacteraemia was present in 24.5% of all UTI patients, and 1.7% of these were caused by a CR pathogen. The most frequent CR pathogens were Pseudomonas aeruginosa (49.4%) and Klebsiella pneumoniae (14.2%). Patients with CR infections had a significantly longer hospital length of stay (LOS) (median [range] 8 [5–12] days vs 6 [4–10] days, P

Device scaling for future semiconductor technologies is driving the adoption of innovative methods for miniaturizing semiconductor chips. One promising approach that has garnered significant interest for sub-10 nm device scaling is area selective deposition (ASD). In this study, we demonstrate the feasibility of ASD of silicon dioxide (SiO2) on –OH terminated surfaces (silicon oxide: SiOx) but not on –NH terminated surfaces (silicon nitride: SiNx) for 2D blanket, 2D patterned, and 3D stacks using a novel precursor: Orthrus. To achieve this, we optimized the SiOx and SiNx layers to enhance the –OH and –NH surface bonds, respectively. Using x-ray photo spectroscopy analysis, we showed that SiO2 selectively deposits on SiOx without any nucleation delay compared to SiNx. We have demonstrated the inherent selective deposition of approximately ∼4 nm on 2D patterned structures and ∼3.7 nm on 3D stacks by fine-tuning the atomic layer deposition process. This selective thickness is >250% compared to a previously shown selective SiO2 deposition process in the literature. Finally, we also showed that the step coverage of selective SiO2 growth in 3D stacks is ∼1. This study highlights the potential pathway for performing ASD of commonly used SiO2 in 3D high-aspect-ratio stacks. [ABSTRACT FROM AUTHOR]

BackgroundMET exon 14 skipping mutation (METex14) is observed in ~3% of non-small cell lung cancer (NSCLC) cases and has been shown to be an independent poor prognostic factor associated with shorter overall disease-specific survival. Broad molecular testing can identify this biomarker in patients with advanced NSCLC (aNSCLC) and allow patients to be matched with the appropriate targeted therapy. This study examines biomarker testing patterns and clinical outcomes of chemotherapy and immuno-oncology (IO) monotherapy in aNSCLC patients with METex14.MethodsA descriptive retrospective study was conducted using the Flatiron Health–Foundation Medicine Inc. (FMI) clinico-genomic database. Patients with METex14 aNSCLC treated with systemic therapies were included in the biomarker testing analysis. The duration from specimen collection to reported results was assessed for PD-L1– and METex14-tested patients. Clinical outcomes were assessed in patients treated with chemotherapy or IO monotherapy. First-line (1L) and second-line (2L) real-world progression-free survival (rw-PFS) were estimated using Kaplan-Meier analysis.ResultsOf 91 METex14 patients eligible for the biomarker testing analysis, 77% and 60% received PD-L1 and FMI next-generation sequencing (NGS) testing within 3 months post aNSCLC diagnosis. Of those assessed for both PD-L1 and METex14 (n=9), the median duration between specimen collection and reporting was 1 week shorter for PD-L1 than for FMI NGS. Median 1L rw-PFS was 5.7 months (95% CI, 4.6-7.1) and 2.4 months (95% CI, 1.4-3.2) in patients receiving 1L chemotherapy (n=59) and IO monotherapy (n=18), with 3-month 1L rw-PFS rates of 78% and 33%. Median 2L rw-PFS was 3.5 months (95% CI, 1.9-11.1) and 4.7 months (95% CI, 2.8-12.9) in patients receiving 2L chemotherapy (n=16) and IO monotherapy (n=23), with 3-month 2L rw-PFS rates of 54% and 67%.ConclusionsThe median time from biopsy to test results appears 1 week shorter for PD-L1 than for FMI NGS. Chemotherapy and IO monotherapy were the most common regimens utilized but with limited PFS.

Category: Ankle; Sports Introduction/Purpose: There is minimal literature on the use of suture-tape augmentation in the treatment of chronic lateral ankle instability (CLAI), prompting an investigation on its use and effect during surgery of the lateral ankle. The purpose of this systematic review is to evaluate the evidence for the use of suture-tape augmentation in the treatment of CLAI, and the outcomes following this technique. Methods: A literature search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they evaluated the use of suture-tape for CLAI. Quantitative and qualitative analysis was performed. Results: There were 11 studies (LOE II: 2, LOE III: 1, LOE IV: 8) with 334 patients and 334 ankles, and 66.7% were females. The mean age of patients was 27.3 years. The mean follow-up was 27.6 months (range: 11.5-38.5). Overall, 9 recurrent instability events (4.1%) were reported for suture-tape augmentation, with no significant difference between Modified Broström repair and suture-tape augmentation (MD;.81, 95% CI,.19, 3.50, I2 = 0%, p = 0.78). There was no significant difference in talar tilt angle (TTA) improvement between Modified Broström repair and suture-tape augmentation (MD; -0.07, 95% CI, -0.68, 60.54, I2 = 0%, p = 0.82). There was no significant difference in anterior talar translation (ATT) improvement between Modified Broström repair and suture-tape augmentation (MD; -0.06, 95% CI, -0.69, 0.56, I2 = 0%, p = 0.84). Conclusion: Suture-tape augmentation did not significantly improve clinical or radiological outcomes in the setting of Modified Broström repair for CLAI. Quicker return to play was the single most important advantage of the suture-tape augmentation procedure identified in the current study. This indicates that there is a role for suture-tape augmentation in ATFL repair for athletes and high-demand patients.