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Background: Normal knee kinematics is characterized by posterior femorotibial rollback with tibial internal rotation and medial-pivot rotation in flexion. Cruciate-retaining TKAs (CR-TKAs) do not reproduce normal knee kinematics.Questions/purposes: We hypothesized a more anatomic reconstruction of the medial femoral condyle, simultaneously preserving the tension of the PCL and medial collateral ligament, resulted in (1) medial-pivot rotation and tibial internal rotation, (2) lateral femoral rollback, and (3) reduced liftoff.Patients and Methods: We compared 10 patients who underwent CR-TKA using the new technique at their 1-year followup to a matched control group of nine patients using a traditional gap-balancing technique at their 2- to 4-year followup. All patients received lateral radiographs in extension and flexion, which we utilized for three-dimensional implant matching to calculate tibial internal rotation, lateral rollback, and lateral liftoff in extension and flexion.Results: The new gap-balancing technique resulted in a median of 3.5° tibial internal rotation with 2.7-mm rollback of the lateral femoral condyle relative to the medial condyle in flexion, which was different from the control group. We found no differences in liftoff between the groups.Conclusions: The new technique resulted in tibial internal rotation with flexion and lateral rollback comparing the lateral to the medial condyle in flexion, but no differences in condylar liftoff. These preliminary results were comparable to published kinematic results of an asymmetric CR-TKA or medial-pivot CR-TKA but not to symmetric CR-TKA. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective study of patients with scoliosis and an Arnold Chiari I malformation requiring operative management.Objectives: Determine the factors that could predict whether a particular spinal deformity might progress despite neurosurgical management of Arnold Chiari I malformation.Summary Of Background Data: Few studies have documented the relationship between diagnosis and treatment of Arnold Chiari I malformation and associated spinal deformities. Most studies mix neural axis abnormalities and contain limited information about the spinal deformity.Methods: Medical records, radiographs, and magnetic resonance images of patients were evaluated focusing on age and findings at presentation, characteristics of presenting and follow-up spinal deformities, and the specifics of neurosurgical and orthopedic management. Patients were divided into two groups: those whose curves progressed >10 degrees or to surgical range (largest curve >45 degrees ) after neurosurgical intervention (progressors) and those whose curves stabilized or decreased (nonprogressors).Results: Eight progressors presented at an average age of 11.4 years (range 2-19) and were followed for 6.3 years (range 2-15). Seven nonprogressors presented at 6.5 years of age (range 5-10) and were followed for 6.6 years (range 3.5-14). Neurosurgical procedures were equivalent in both groups; however, surgical revisions were required in 3 out of 8 progressors and 1 out of 7 nonprogressors. All progressors had a double scoliosis curve; but only one nonprogressor had a double curve. Six out of 8 progressors and 0 out of 7 nonprogressors had a rotation >or=2+ and 50% of progressors had a thoracic kyphosis >50 degrees compared to 1 out of 7 nonprogressors.Conclusions: In this series, progression of spinal deformity after neurosurgical management of Arnold Chiari I malformation was associated with later age at neurosurgical decompressions and initial neurologic symptoms, double scoliosis curve patterns, kyphosis, rotation, and larger curve at presentation. [ABSTRACT FROM AUTHOR]

Dysregulation of fatty acid storage and release by adipose tissue contributes to the pathophysiology of insulin resistance and diabetes. Adiponutrin is a newly discovered enzyme involved in triglyceride metabolism in adipose tissue. To elucidate the regulation of adiponutrin gene expression, we quantitated adiponutrin mRNA in adipose tissue of lean and obese subjects, and in response to elevated insulin or fatty acids. Adiponutrin mRNA was measured by Real-Time RTPCR in subcutaneous adipocytes from 9 lean (8 men/1 women; BM122.2±0.6 kg/m²), 3 overweight (3 men; BMI 27.3±1:0.9 kg/m² and 9 obese subjects (7 men/2 women; BM136.9±2.1 kg/m²). Of the obese subjects 5 had type 2 diabetes. There was a significant negative correlation between adiponutrin mRNA and adiposity (r=0.423; P=0.008). To examine insulin regulation of adiponutrin, abdominal subcutaneous adipose tissue biopsies were obtained before and at the end of a 240 min hyperinsulinemic-euglycemic clamp at an insulin dose of 120 mUm[sup -2]min[sup -1]. Eleven subjects were studied including 3 lean (2 men/1 woman BMI 22.9±1.1 kg/m²), 3 obese (3 men, BMI 36.6±4.2 kg/m²) and 5 obese type 2 diabetics (4 men/l women, BMI 37.6±2.2 kg/m²). Adiponutrin mRNA increased 426±114% over control (0.43±0.13 vs 2.52±0.98 relative units; P =0.013) by the end of the clamp in all subjects combined. To examine the regulation of adiponutrin by FFA, intralipid (20%; 45 ml/h) plus heparin (0.2 U/kg/min) was infused for 360 min in seven subjects (4 lean men, BMI 21.2±0.3 Iw:,/m², age 53±3 y and 3 overweight subjects (2 men/l woman, BMI 27.7±1.2 kg/m², age 41±4 y). Serum FFA was increased approximately 2-3 fold during the clamp and insulin values remained unchanged (7.2±0.7 and 7.8±1.9 µU/ml, before and at end of infusion respectively, P=NS). Increased serum FFA resulted in a significant decrease in adiponutrin mRNA (3.96±0.50 vs 1.91±0.49 relative units; P=0.028). In contrast TNFα mRNA in subcutaneous adipocytes was significantly increased with FFA infusion (0.28±0.09 vs 0.53±0.07; P=0.03). Overall the increase in adiponutrin mRNA with insulin, and decrease with FFA treatment suggest that adiponutrin have a role in promoting the storage of triglyceride in human adipose tissue. ADA-Funded Research [ABSTRACT FROM AUTHOR]

Study Design: Cross-sectional study., Objective: To evaluate for areas of consensus and divergence of opinion within the spine community regarding the management of cervical spondylotic conditions and acute traumatic central cord syndrome (ATCCS) and the influence of the patient's age, disease severity, and myelomalacia., Summary of Background Data: There is ongoing disagreement regarding the indications for, and urgency of, operative intervention in patients with mild degenerative myelopathy, moderate to severe radiculopathy, isolated axial symptomatology with evidence of spinal cord compression, and ATCCS without myelomalacia., Methods: A survey request was sent to 330 attendees of the Cervical Spine Research Society (CSRS) 2021 Annual Meeting to assess practice patterns regarding the treatment of cervical stenosis, myelopathy, radiculopathy, and ATCCS in 16 unique clinical vignettes with associated MRIs. Operative versus nonoperative treatment consensus was defined by a management option selected by >80% of survey participants., Results: Overall, 116 meeting attendees completed the survey. Consensus supported nonoperative management for elderly patients with axial neck pain and adults with axial neck pain without myelomalacia. Operative management was indicated for adult patients with mild myelopathy and myelomalacia, adult patients with severe radiculopathy, elderly patients with severe radiculopathy and myelomalacia, and elderly ATCCS patients with pre-existing myelopathic symptoms. Treatment discrepancy in favor of nonoperative management was found for adult patients with isolated axial symptomatology and myelomalacia. Treatment discrepancy favored operative management for elderly patients with mild myelopathy, adult patients with mild myelopathy without myelomalacia, elderly patients with severe radiculopathy without myelomalacia, and elderly ATCCS patients without preceding symptoms., Conclusions: Although there is uncertainty regarding the treatment of mild myelopathy, operative intervention was favored for nonelderly patients with evidence of myelomalacia or radiculopathy and for elderly patients with ATCCS, especially if pre-injury myelopathic symptoms were present., Level of Evidence: Level V., Competing Interests: B.C.: DePuy, A Johnson & Johnson Company: IP royalties, SpinologyTenex: Stock or stock options, Surgalign: paid consultant, Wolters Kluwer Health-Lippincott Williams & Wilkins: publishing royalties, financial or material support, Zimmer: IP royalties. B.A.F.: Ankasa: research support, AO Spine: paid presenter or speaker, Clear Choice Therapeutics: stock or stock options, Kuros: paid consultant, Medtronic: paid consultant; research support, Neuroinnovations: stock or stock options, Synthes: paid consultant, Theradaptive: paid consultant. A.N.N.: American Orthopaedic Association: Board or committee member, AO Spine: research support, Cervical Spine Research Society: Board or committee member, Lumbar Spine Research Society: Board or committee member, Pfizer: research support, Premia Spine: research support, Scoliosis Research Society: Board or committee member, Techniques in Orthopedics: editorial or governing board. B.A.K.: Clinical Spine Surgery: editorial or governing board. A.S.S.: Cerapedics: paid consultant; paid presenter or speaker, CTL Amedica: IP royalties, DePuy, A Johnson & Johnson Company: paid consultant, Jaypee Publishers: IP royalties. J.M.R.: Alphatec Spine: paid consultant; paid presenter or speaker, Biomet: IP royalties, Cervical Spine Research Society: Board or committee member, Medtronic: paid presenter or speaker, Stryker: IP royalties; paid presenter or speaker, Wolters Kluwer Health-Lippincott Williams & Wilkins: publishing royalties, financial or material support, Zimmer: paid presenter or speaker. M.G.F.: Neuraxis: paid consultant. The remaining authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Strategic Priority 4 (SP4) of the Immunization Agenda 2030 aims to ensure that all people benefit from recommended immunizations throughout the life-course, integrated with essential health services. Therefore, it is necessary for immunization programs to have coordination and collaboration across all health programs. Although there has been progress, immunization platforms in the second year of life and beyond need continued strengthening, including booster doses and catch-up vaccination, for all ages, and recommended vaccines for older age groups. We note gaps in current vaccination programs policies and achieved coverage, in the second year of life and beyond. In 2021, the second dose of measles-containing vaccine (MCV2), given in the second year of life, achieved 71% global coverage vs 81% for MCV1. For adolescents, 60% of all countries have adopted human papillomavirus vaccines in their vaccination schedule with a global coverage rate of only 12 percent in 2021. Approximately 65% of the countries recommend influenza vaccines for older adults, high-risk adults and pregnant women, and only 25% recommended pneumococcal vaccines for older adults. To achieve an integrated life course approach to vaccination, we reviewed the evidence, gaps, and strategies in four focus areas: generating evidence for disease burden and potential vaccine impact in older age groups; building awareness and shifting policy beyond early childhood; building integrated delivery approaches throughout the life course; and identifying missed opportunities for vaccination, implementing catch-up strategies, and monitoring vaccination throughout the life course. We identified needs, such as tailoring strategies to the local context, conducting research and advocacy to mobilize resources and build political will. Mustering sufficient financial support and demand for an integrated life course approach to vaccination, particularly in times of COVID-19, is both a challenge and an opportunity., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 World Health Organization. Published by Elsevier Ltd.. All rights reserved.)

Background: Metacarpal fracture fixation using the retrograde intramedullary screw technique can be performed through two different approaches. The mini-open approach requires greater soft tissue dissection but allows for direct visualization of the metacarpal head compared with the percutaneous approach. Our aim was to determine which approach resulted in optimal screw position., Methods: Eighty-one consecutive patients that underwent intramedullary screw fixation for metacarpal fractures from 2016 to 2021 were identified. Patients were treated by 4 fellowship-trained orthopedic hand surgeons who employed the mini-open or percutaneous approach. Postoperative radiographs were reviewed for screw position., Results: A total of 81 patients (41 mini-open, 40 percutaneous) were included in this study. There were no significant differences between the two groups in age, sex, hand dominance, or affected digit. Postoperative screw position at first postoperative visit was not significantly different between the two groups on anteroposterior or lateral radiographs., Conclusion: Postoperative screw position is not significantly different between the mini-open and percutaneous approaches for intramedullary screw fixation of metacarpal fractures., Level of Evidence: Level III, therapeutic., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Vegetable waste has numerous essential values and can be used for various purposes. Unfortunately, it is often discarded worldwide due to a lack of awareness regarding its nutritional and practical significance. Even the nutrient-rich peels of fruits and vegetables are commonly wasted, despite their numerous useful applications. Utilizing vegetable waste to produce silver nanoparticles through green synthesis is an advantageous, economical, and environmentally friendly method for producing valuable products while addressing waste management concerns. The main emphasis of this study was to synthesize silver nanoparticles (AgNPs) by using vegetable waste from Solanum tuberosum (potato) and Coriander sativum (coriander)., Methods: The stems of Coriander sativum and peels of Solanum tuberosum were used as extracts for the synthesis of AgNPs. The characterization of the synthesized AgNPs involved UV-spectroscopy, scanning electron microscopy (SEM), and X-ray diffraction (XRD). The phytochemical analysis was performed to analyze antimicrobial, cytotoxic, antidiabetic, antitumor, antioxidant, alpha-amylase, and protein inhibition activities., Results: The change in the color of the reaction mixture from yellowish green to brown following the addition of extracts to the silver nitrate solution confirmed nanoparticle synthesis. UV analysis has shown peaks in the range of 300-400nm. SEM confirmed the spherical and agglomerated morphology and size of 64nm for potato peel and 70nm for coriander stem. XRD confirmed the crystalline structure of silver nanoparticles. The phytochemical assays confirmed that silver nanoparticles had higher total phenolic and flavonoid contents. The biosynthesized silver nanoparticles showed promising antimicrobial, cytotoxic, antidiabetic, antitumor, and antioxidant properties and significant alpha-amylase and protein inhibition activities in comparison with the crude extracts., Conclusion: The bioactivity of the plant suggests that it could be a suitable option for therapeutic purposes. This study demonstrates a potential method for sustainable nanoparticle synthesis and the therapeutic applications of AgNPs derived from vegetable waste. By utilizing the potential of vegetable waste, we can contribute to both environmental sustainability and the development of innovative, valuable products in fields such as medicine, agriculture, and materials science. These findings encourage further research on agricultural byproducts, promoting environmentally friendly and economically advantageous research and development efforts., Competing Interests: The authors report no conflicts of interest in this work., (© 2023 Kiani et al.)

Breakthrough advances in protein therapeutics and sustained release systems continue to fuel innovation in novel, non-invasive polymeric platforms for delivery of biologicals. Despite the bench potential and proof-of-concept work, market analysis still shows biologicals to be predominantly injections. Characterized by insufficient secretion of growth hormone by the pituitary gland, growth hormone deficiency (GHD) is a rare disorder. Currently, chronic somatropin (r-hGH) replacement therapy is only available as subcutaneous injections administered several times a week. We aim to prepare large, porous, biodegradable and aerodynamically light microparticles as tunable carriers for pulmonary r-hGH delivery. We developed a range of microparticles using PLGA 5050 1Awith sizes between 5 μm and 13 μm, densities lower than 0.4 g/cc and aerodynamic diameters lower than 6 μm. Polyethylene glycol's multitude of advantages - plasticizing PLGA, improving the biocompatibility of the system and preventing protein burst release - have been extensively studied, making it our excipient (pore-former) of choice. Drug loading was characterized at pH 4.0 (acidic), 5.3 (pI) and pH 7.2 (neutral) and was a result of an interplay of electrostatic and hydrophobic interactions between the polymer and somatropin. Considering the physicochemical interactions, we observed some pH dependent protein unfolding characterized by reduction in intrinsic fluorescence of the Tryptophan 86 residue at 331 nm. The secondary ⍺-helix structure characterized by 2 negative minima at 209 nm and 222 nm in the circular dichroism spectra, was intact at all pH values. R-hGH was released over a period of seven days, and the release profile was a function of the microparticle porosity., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Purpose: Both limited-open and percutaneous techniques have been described for retrograde insertion of intramedullary metacarpal screws. The percutaneous approach does not allow direct visualization of the starting point at the metacarpal head. However, it limits soft tissue dissection and expedites the procedure. The purpose of our study was to determine whether percutaneous, retrograde intramedullary screw fixation causes substantial iatrogenic damage to the extensor tendon. We also investigated whether larger sized screws would cause greater tendon injury compared to smaller screws., Methods: Eight fresh frozen cadaver hands were used for percutaneous, retrograde intramedullary screw insertion of the index, long, ring, and small finger metacarpals of each specimen. Three different types of headless compression screws were used: a small fully threaded screw, a large fully threaded screw, and a Herbert-style partially threaded screw. After insertion, dissection was carried down to the screw entry site. Extensor tendon damage was evaluated, including tendon defect size and any irregularities noted in the tendon., Results: There was no statistical difference with respect to how frequently a screw perforated the extensor tendons between all four finger metacarpals. Overall, the defect width caused by the screw was minimal, ranging from 0.66 mm to 1.89 mm for all finger and screw types. The large style screw did cause the greatest mean defect width, however, this was not statistically significant. When normalized to total tendon width, the defect was less than 28% of the total tendon width, with an average of 20% for all finger and screw types. Upon gross inspection, there was no fraying or irregularity noted at the screw-tendon insertion site, and it was often difficult to identify the screw entry site through the tendon by direct visualization alone. No tendon ruptures were noted., Conclusions: This study found that percutaneous insertion of a retrograde, intramedullary metacarpal screw causes minimal extensor tendon injury. In contrast to the limited-open approach, the percutaneous technique requires less soft tissue dissection and the possibility of reduced swelling, scarring, and risk of adhesions. Moreover, it has the potential to allow for early functional rehabilitation and reduced operative time. Interestingly, none of the tendons demonstrated fraying or rupture, as one might expect to occur with blind passage of a drill and screw through a tendon. Overall, the percutaneous, retrograde intramedullary screw technique appears to cause minimal iatrogenic injury to the extensor tendon.

Background: Medicare (MCR) and Medicaid (MCD) remain the dominant providers of government-funded health insurance in the United States. The purpose of this study was to evaluate the variability between MCR and MCD reimbursements for common hand and wrist surgical procedures. We hypothesized that MCD reimbursement rates would have substantial variation between states, whereas MCR rates would remain relatively constant., Methods: Using the Medicare Physician Fee Schedule Database, the 2019 reimbursements for 7 common hand and wrist procedures were recorded via the respective Current Procedural Terminology codes. The MCD reimbursement rates were then obtained from each state's physician fee schedule database. Comparisons of reimbursement for these procedures were then calculated between states and between MCD and MCR while adjusting for cost of living using the Medicare Wage Index. Finally, the coefficients of variation were computed to compare the extent of variability between the insurance types., Results: Across all procedures, reimbursement rates for MCD ranged from 30.6% to 240% of the average MCR reimbursement, with the mean reimbursement for MCD valued at 78.3% of MCR. Endoscopic carpal tunnel release (CTR) is valued similarly by MCD compared with open CTR with an average of 77.7% and 78.2% reimbursement of MCR, respectively. The coefficients of variation for MCD reimbursements ranged from 0.25 to 0.45, whereas the value was 0.06 for all MCR procedures., Conclusions: These findings demonstrate a wide variation in MCD payments between states. When compared with MCR, the lower average state MCD reimbursement questions the sustainability for hand surgeons to accept these patients in practice.

Age-related macular degeneration (AMD) is a macular degenerative eye disease, the major cause of irreversible loss of central vision. In this review, we highlight current progress and future perspectives of novel and investigational therapeutic strategies in the drug pipeline, including anti-vascular endothelial growth factor (VEGF) agents, bispecific antibodies, biosimilars, small molecules, gene therapy, and long-acting drug delivery strategies for both dry and wet AMD. We anticipate that biologics with dual functionalities and combined therapies with long-acting capabilities will lead the wet AMD pipeline. Sustained-release platforms also show potential. However, significant breakthroughs are yet to be made for dry AMD. The personalized approach might be well suited in the scenario of diverse genetic variations in both conditions., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction:  Beginning on January 1, 2021, the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS) implemented considerable revisions with regard to the outpatient evaluation and management (E/M) criteria dictating the Current Procedural Terminology (CPT) code level selection. The primary goal of the current study was to determine how the recent E/M coding criteria changes have impacted code level selection by orthopedic hand surgeons in the outpatient setting., Materials and Methods:  All outpatient visits within the hand and wrist surgery division of a single orthopedic practice were collected during two timeframes: March 1, 2019, to June 30, 2019, and March 1, 2021, to June 30, 2021. Procedure codes and insurance categories were collected for each visit. The primary endpoint analyzed was the visit level of care based on CPT E/M codes. For each timeframe, we determined the number of total visits that were coded at each level and expressed them as a percentage of the total visits for that time period. The insurance plan billed for each visit was recorded and classified as Medicare, Medicaid, Workers' Compensation, or commercial., Results:  In 2019, prior to the billing level requirement changes, 7.2% of all visits were billed as level 2, 84.8% of all visits were billed as level 3, and 7.8% of all visits were billed as level 4. In 2021, 1.9% of visits were billed as level 2, 47.3% of visits were billed as level 3, and 50.5% of visits were billed as level 4. Level 1 and 5 visits did not exceed 0.5% in either timeframe. Within each insurance category, the proportion of visit levels of care followed a similar trend of reduced level 2 and 3 visits and increased level 4 visits from 2019 to 2021., Conclusion: We noted a significant trend toward higher code level selection following the recent code level changes, and we anticipate these recent code selection trends to have major financial implications moving forward., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Graham et al.)

Background Telehealth platforms may save resources for patients and providers, but the precise impact of their incorporation during the postoperative period is not well understood. The goal of this study is to determine whether telehealth incorporation in the postoperative period leads to an overall increase in healthcare utilization after upper extremity surgery. Methodology Patients seen for a postoperative telehealth visit after upper extremity surgery were randomly selected and retrospectively enrolled. Complications and the total number of postoperative visits before clinical discharge were recorded and compared to controls matched by surgery type and surgeon. Results A total of 56 patients were seen for 60 telehealth visits. The most common surgical procedures were distal radius open-reduction internal fixation (n = 8), open carpal tunnel release (n = 8), and endoscopic carpal tunnel release (n = 6). One telehealth visit (1.7%) required conversion to in-person evaluation due to suspected superficial infection necessitating in-person physical examination. The average number of postoperative visits prior to clinical discharge was 2.6 in the telehealth group compared to 2.7 in matched controls (p = 0.886). Complication rates were similar between groups. Conclusions The rate of necessary in-person evaluation after postoperative telehealth visits was less than 2%. The incorporation of telehealth visits did not appear to increase healthcare utilization after upper extremity surgery. Accordingly, the postoperative period is likely an ideal application for safe and effective telehealth implementation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Henry et al.)

Background Competition for patients among orthopaedic private practices, multi-specialty groups, and hospital systems continues to persist. An effective marketing campaign is essential for a practice to succeed in this competitive environment. The purpose of this study was to investigate the cost-effectiveness and efficacy of each marketing campaign and the influence of patient demographics on efficacy. Methods The first 300 consecutive, new patients were prospectively surveyed on how they initially discovered and then selected the orthopaedic practice. Demographics and marketing costs were tabulated and categorized to analyze the effectiveness of each marketing strategy. Results A substantial portion of the marketing budget was allocated for traditional (67.0%) and online advertising (25.0%). However, only 56/300 (18.7%) patients surveyed were brought to the practice by these methods combined. In contrast, expenditure on a marketing liaison (8.0%) delivered 128 patients (42.7%) through referrals: 80 (26.7%) from physicians, 28 (9.3%) from urgent cares, 17 (5.7%) from physical therapists, and 3 (1.0%) from attorneys. Conclusion Marketing strategies were not proportionally beneficial during the first six months of the orthopaedic practice start-up period. During this early ramping up period, the most cost-effective marketing strategy was utilization of a liaison for direct in-person visits to various healthcare facilities., Competing Interests: The authors have declared financial relationships, which are detailed in the next section., (Copyright © 2021, Antonacci et al.)

Introduction: In response to the SARS-CoV-2 pandemic, physician attire has evolved to incorporate personal protective equipment (PPE). Although PPE is mandated for all healthcare workers, variability exists in choice and availability. The purpose of this study was to determine patient perception of physician attire during the COVID-19 pandemic in an outpatient setting., Methods: Three hundred sixty-eight patients who presented to our outpatient orthopaedic clinics completed an anonymous survey. In addition to demographic characteristics, patient preferences for attire, PPE, and social distancing were obtained., Results: Scrubs (81%, 298/368) were found to be the most acceptable physician attire. Eye protection (34.2%, 126/368) and gloves (32.6%, 120/368), however, were deemed much less acceptable; 93.5% (344/368) of patients reported that no mask was unacceptable, with 41.0% (151/368) preferring a surgical mask. Predilection for a surgical mask and N95 rose with increasing patient education level. Interestingly, 55.2% (203/368) responded that physicians should stop wearing PPE only when the Center for Disease Control recommends., Conclusion: During the COVID-19 pandemic, most of the patients found scrubs to be the most acceptable attire in an office-based outpatient setting. Patients also found physician mask-wearing to be important but are less accepting of providers wearing eye and hand protection., (Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

Introduction Hand and upper extremity surgeries are largely performed in free-standing ambulatory surgery centers (ASCs). Rates of unexpected hospitalizations or visits to the urgent care or emergency departments in the month following hand and upper extremity surgery have been widely varied in the literature. We prospectively followed patients after hand and upper extremity outpatient surgery to determine the rate of unplanned health care utilization with the hypothesis that hospital admissions, emergency room visits, and urgent care center visits would be higher than the rates currently reported by retrospective studies. Methods All patients undergoing outpatient hand and upper extremity surgery by five hand surgeons were prospectively followed to monitor for hospital readmissions, emergency room visits, and urgent care presentations. The patients' postoperative course was evaluated for direct transfers from the surgical center to the hospital. In addition, any urgent care or emergency room visits and hospital admissions for the first month after surgery were tabulated. Points of review of the patients' postoperative course included the following: (1) phone contact on the first postoperative day, (2) routine ASC postoperative phone calls two to three days postoperatively, (3) first postoperative office at approximately one to two weeks, and (4) phone contact or office evaluation one-month postoperatively based on surgeon preference for follow-up. Results A total of 583 patients were identified for participation, of whom 22 patients were excluded; thus, 561 patients were included for evaluation, with 47.2% women (n=265) and 52.8% men (n=296). The average age was 54 years (range: 14-102 years). Nine (1.6%) patients presented postoperatively for further evaluation at an urgent care or hospital (95% C.I. 0.8-3.1%). Five patients presented to an emergency room and four patients presented to an urgent care facility. Of those patients, two were admitted to the hospital due to shortness of breath (0.35%; 95% CI: -0.08 to 1.4%). Emergency room and urgent care visits that did not lead to admission accounted for 1.25% (95% CI: 0.6-2.6%). No patients were transferred from the ASC to the hospital or emergency room. Conclusion There was a low rate of postoperative utilization of urgent care and emergency room services with hand and upper extremity surgery performed at free-standing, ASCs. Hospital readmissions were rare, and no patients required transfer from an ambulatory care center to the hospital. Outpatient hand and upper extremity surgery is safe in an ambulatory care center, with low postoperative transfers and readmissions in the month following surgery., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Sandrowski et al.)

Treatment of brain-related diseases is one of the most strenuous challenges in drug delivery research due to numerous hurdles, including poor blood-brain barrier penetration, lack of specificity, and severe systemic toxicities. Our research primarily focuses on the delivery of natural therapeutic compound, α-asarone, for the treatment of brain-related diseases. However, α-asarone has poor aqueous solubility, bioavailability, and stability, all of which are critical issues that need to be addressed. This study aims at formulating a lipid nanoparticulate system of α-asarone (A-LNPs) that could be used as a brain drug delivery system. The physicochemical, solid-state properties, stability, and in vitro and in vivo studies of the A-LNPs were characterized. The release of α-asarone from the A-LNPs was prolonged and sustained. After intravenous administration of A-LNPs or free α-asarone, significantly higher levels of α-asarone from the A-LNPs were detected in murine plasma and brain parenchyma fractions, confirming the ability of A-LNPs to not only maintain a therapeutic concentration of α-asarone in the plasma, but also transport α-asarone across the blood-brain barrier. These findings confirm that lipid nanoparticulate systems enable penetration of natural therapeutic compound α-asarone through the blood-brain barrier and may be a candidate for the treatment of brain-related diseases.

Background: Measles incidence and mortality rates have significantly decreased since vaccine introduction. Despite this progress, however, there has been a global resurgence of measles. To understand the current global epidemiology, we analyzed measles surveillance data., Methods: We analyzed data on measles cases from 2013-2018 reported to the World Health Organization. Univariate analysis was undertaken based on age, vaccination history, onset year, World Health Organization region, and World Bank income status for the country where the case was reported, and a surrogate indicator of the historical strength of the country's immunization program. Annual incidence and a 2013-2018 mean country incidence per million were calculated., Results: From 2013 through 2018, there were 899 800 reported measles cases, of which 57% occurred unvaccinated or undervaccinated persons, with an unknown vaccination history in another 30%. Lower-middle-income countries accounted for 66% of cases, 23% occurred in persons ≥15 years of age. In countries with stronger historical vaccination programs and higher country income, case patients had higher median ages., Conclusions: Although most measles case patients are <15 years of age, an age shift is seen in countries with a higher income or a stronger historical vaccination program. Countries must strengthen immunization programs to achieve high vaccination coverage; some must undertake strategies to reach persons ≥15 years of age and close immunity gaps., (© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)