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Hasani W Swindell,1 Venkat Boddapati,1 Julian J Sonnenfeld,1 David P Trofa,1 James E Fleischli,2 Christopher S Ahmad,1 Charles A Popkin1 1Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY, USA; 2Shoulder and Elbow Center, OrthoCarolina Sports Medicine Center, Charlotte, NC, USACorrespondence: Charles A PopkinDepartment of Orthopedic Surgery, Columbia University Medical Center, 622 West 168th Street, PH – 11, New York, New York 10032, USATel +1 212-305-4787Email cp2654@columbia.eduPurpose: Although often performed using a variety of reconstructive techniques and strategies, no clinically significant differences presently exist between the approaches available for isolated PCL reconstructions. Given the operatively challenging nature of these procedures, there lies a potentially increased risk of postoperative complications and healthcare expenditures. Our investigation sought to identify patient and surgical risk factors associated with prolonged hospital stays following isolated PCL reconstruction and determine the incidence of 30-day complications after PCL reconstruction using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database.Method: Patients undergoing isolated PCL reconstructions between 2005 and 2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database using Current Procedural Terminology codes. Baseline patient and operative characteristics were evaluated as possible risk factors for overnight hospital admissions following PCL reconstruction and analyzed using multivariate analyses.Results: A total of 249 patients were identified. Multivariate analyses demonstrated that increased operative duration >120 mins (OR 5.04, CI 2.44–10.40; p 120 mins carried an increased risk of overnight hospital stay after isolated PCL reconstructions. As there are presently minimal significant clinical differences between current PCL reconstruction techniques, improved surgeon familiarity and comfort with a single technique is recommended to decrease operative time and avoid prolonged hospital stays and healthcare expenditures.Level of evidence: III, retrospective comparative study.Keywords: operative time, overnight hospital stays, healthcare expenditures, American College of Surgeons National Surgical Quality Improvement Program, NSQIP

The article presents an examination of the ostensibly basic human need for open space and exposure to elemental nature. Though often used to describe similar attributes of an environment, space and landscape are not quite equivalent. Space clearly is conceptually abstract, while landscape, though it involves environmental features distributed in space, is both more specific and more variable. The one constitutes a perception in which the mental contribution is the primary variable; the other constitutes a visual sensation in which the mental imagery is a fairly close duplicate of what in fact exists. The two key attributes of spatial adequacy appear to be isolation and difference. The determinants of spatial adequacy, both in its isolation and difference dimensions, lie in part in the nature of the space and in part in the individual and the constraints on his activities. Given the occurrence of change in personal values and demands for space and landscape, and change also in the availability of space and landscape for the satisfaction of existing values and demands, an adaptive mechanism would seem to be necessary whereby, at least in western societies, increasingly affluent and concerned populations will be able to accommodate to continued reductions in controllable space or landscape.

Background: Glenohumeral instability is a challenging problem in children and adolescents. For patients with anterior glenoid bone loss, the Latarjet procedure is an effective treatment option. However, concerns about coracoid size and morphology may limit its utilization within this patient population. The purpose of this study was to establish normative data on coracoid and glenoid size and morphology among a large cohort of adolescent patients and describe the anatomic relationships with demographic factors., Methods: This is a retrospective cross-sectional study of a consecutive series of 584 patients aged 12-21 years after a chest computed tomography scan for non-shoulder related trauma at a single level I trauma center. Demographic characteristics were collected from the electronic medical record, and the following coracoid anatomic measurements were obtained from computed tomography scans: coracoid length, coracoid thickness, coracoid width, glenoid height, and glenoid width. The ratio of coracoid thickness to glenoid width was calculated to estimate the percent bone loss that could be addressed with a traditional Latarjet coracoid transfer. To ensure reliability among 3 reviewers, all measured the same 25 scans and inter-rater reliability was excellent with all Kappa coefficients >0.81. The remaining scans were divided equally and assessed separately by these reviewers. Correlation coefficients were used to quantify the relationships between all anatomic measures and the age, weight, and height of individuals. Growth curves for each measurement were modeled using quantile regression with height and height∗height as predictors. Additionally, we stratified the growth curves by sex, when significant. Of the 584 subjects, 55% were male, and average age was 19 years (range 12, 21)., Results: All growth curves illustrated increase anatomic size across the height range of 145-190 cm. The growth curve including all patients (Fig. 1) illustrated that the 50% percentile of median coracoid length increased from approximately 28 to 32 mm. In addition to height, sex was a significant predictor for coracoid width and glenoid width. The median coracoid width increased from approximately 9.5 to 10.2 mm for females compared to an increased width from approximately 10 to 11 mm for males. The median glenoid width for females increased from approximately 21 to 25 mm and for males the median glenoid width increased from just under 22 to 25.5 mm., Conclusions: Among children and adolescents, coracoid and glenoid size are correlated with patient height. These data can help guide patient selection for the Latarjet procedure., (© 2023 The Authors.)

Medial epicondylitis, also known as "golfer's elbow," is a common orthopaedic condition that typically results from overuse of the flexor pronator mass. Repetitive eccentric loading of the muscles responsible for wrist flexion and forearm pronation leads to microtrauma and subsequent degeneration of the flexor pronator tendon. Patients with medial epicondylitis typically present in the fourth to sixth decade of life and have an insidious onset of medial elbow pain. Occasionally, medial epicondylitis may result from an acute traumatic event, such as an acute avulsion of the common flexor tendon. Patients should be examined for concomitant elbow pathologies, including ulnar neuritis and ulnar collateral ligament injury. T2-weighted magnetic resonance imaging can show increased signal intensity in the common flexor tendon or a complete rupture. Nonsurgical management is the mainstay of treatment; however, surgical treatment may be indicated in elite athletes and patients with persistent symptoms after conservative treatment. This technique article with accompanying video describes open debridement and repair of the flexor pronator tendon, with an emphasis on restoration of the anatomic footprint and compression across the repair site to promote biological healing., (© 2019 by the Arthroscopy Association of North America. Published by Elsevier.)

Background: Knowledge of nasal carriage is important in predicting staphylococcal infection, and no information exists regarding the endemicity of Staphylococcus aureus in Haiti., Methods: We performed a cross-sectional analysis of S. aureus nasal screening in an acute care, a subacute rehabilitation, and a community setting, with a brief medical and epidemiological history. PCR-positive S. aureus screening nasal cultures underwent molecular analysis for spa type, SCCmec type, and virulence genes (Panton-Valentine leukocidin (PVL), toxic shock syndrome toxin (TSST), and arginine catabolic mobile element (ACME)), and were evaluated for antibiotic susceptibility using commercial tests., Results: Overall carriage rates of 8.4% methicillin-susceptible S. aureus (MSSA) and 2.8% methicillin-resistant S. aureus (MRSA) were identified, with a high rate of tetracycline resistance. TSST and PVL genes were identified in MSSA. MRSA isolates contained no virulence markers. Unique MSSA phenotypes (i.e., linezolid-resistant, vancomycin-sensitive/daptomycin non-susceptible) were identified, as were two PVL-positive ST152 MSSA colonization isolates, previously geographically limited to Africa., Conclusions: We found a low S. aureus carriage rate with complete vancomycin susceptibility and high tetracycline resistance, which has important public health implications with regard to treatment. Additionally, the finding of PVL-positive MSSA isolates, including the expansion of a previously described limited 'divergent' clone, ST152, warrants further evaluation., (Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: Hypertension is an important risk factor for cardiovascular disease throughout the world. Little is known about the prevalence of hypertension in rural Haiti. Our study aims to estimate prevalence and knowledge of hypertension in Northern Haiti., Design: Cross-sectional., Setting: Four rural communities surrounding Milot, Haiti., Participants: Participants (69 males, 106 females, 175 total) were eligible to take part if they were aged > 18 years and not pregnant. Enrollment was voluntary., Methods: Two initial blood pressure measurements were taken for each participant. Participants who had an average systolic blood pressure > or = 140 mm Hg or diastolic blood pressure > or = 90 mm Hg were instructed to return in 1 week for two additional confirmatory measurements. Based on these measures, participants were classified as either hypertensive or not. All participants were surveyed to assess their knowledge of hypertension., Results: The prevalence of hypertension among the study sample was 36.6%. Overall, 47% of women and 21% of men were hypertensive. Approximately 30% of women of reproductive age (18-39 years) were hypertensive. Participants showed little knowledge of the asymptomatic nature of hypertension and the need for lifelong treatment., Conclusions: Hypertension is prevalent in Haiti. The high prevalence of hypertension among women of reproductive age is a concern since it is a risk factor for cardiovascular disease. Lack of knowledge surrounding hypertension indicates low awareness of the condition and is a possible target for future educational interventions.

We report on a novel mouse in vitro brain slice preparation that contains intact callosal axons connecting anterior cingulate cortices (ACC). Callosal connections are demonstrated by the ability to regularly record epileptiform events between hemispheres (bilateral events). That the correlation of these events depends on the callosum is demonstrated by the bisection of the callosum in vitro. Epileptiform events are evoked with four different methods: (1) bath application of bicuculline (a GABA-A antagonist); (2) bicuculline+MK801 (an NMDA receptor antagonist), (3) a zero magnesium extracellular solution (0Mg); (4) focal application of bicuculline to a single cortical hemisphere. Significant increases in the number of epileptiform events, as well as increases in the ratio of bilateral events to unilateral events, are observed during bath applications of bicuculline, but not during applications of bicuculline+MK-801. Long ictal-like events (defined as events >20 seconds) are only observed in 0Mg. Whole cell patch clamp recordings of single neurons reveal strong feedforward inhibition during focal epileptiform events in the contralateral hemisphere. Within the ACC, we find differences between the rostral areas of ACC vs. caudal ACC in terms of connectivity between hemispheres, with the caudal regions demonstrating shorter interhemispheric latencies. The morphologies of many patch clamped neurons show callosally-spanning axons, again demonstrating intact callosal circuits in this in vitro preparation.

A peak-detection method is described for computer analysis of the the electroencephalogramme (EEG). The technique consists of measuring the amplitude and time interval between successive maxima (peaks) and minima (troughs) in the signal. A critical feature of the peak-detection algorithm is the inclusion of an amplitude threshold criterion which eliminates the registration of low-voltage activity riding on EEG waves. The peak-detection procedure permits the formulation of a variety of intra-band and inter-band EEG statistics which can be useful in on-line computer applications. The peak-detection algorithm has been successfully applied to a number of normal and clinical EEG recordings. Although no computer procedure for EEG analysis has yet been universally adopted, the peak-detection algorithm reported in this paper presents a standardised approach which can be used between EEG clinics.