Search

Kayla C Everhart,1 Sara B Donevant,1 Victor N Iskersky,2 Michael D Wirth,1 Robin B Dail1 1College of Nursing, University of South Carolina, Columbia, SC, USA; 2Department of Neonatology, Prisma Health Richland/Pediatrix, Columbia, SC, USACorrespondence: Kayla C Everhart, College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA, Email everhakc@email.sc.eduPurpose: Researchers report associations between packed red blood cell (PRBC) transfusions and morbid outcomes in preterm infants. Published standards are lacking for giving PRBC transfusions to preterm infants in the neonatal intensive care unit (NICU). This study examined standard practices reported by nurses across the United States (US) for administering PRBC transfusions to preterms to identify variation in practice which may contribute to the relationship of PRBC transfusions and morbidity.Design and Methods: A 23-item questionnaire developed using REDCap based on literature and nursing experience of experts on the procedure of administering PRBC transfusions to preterm infants was distributed via social media and email to NICU nurses across the US.Results: A total of 757 responses received and 518 completed responses were analyzed from level IV (48%) and level III (49%) NICU nurses in 47/50 US states. Most (94%) report PRBCs are ordered for anemia. Most (74%) report NICU policies do not specify warming PRBC transfusions prior to infusing; 10% (n = 53) specifically indicate they warm PRBC transfusions. Only 2% report using a blood warmer device. NICU nurses in the US (66%) reported feedings are altered during the PRBC transfusion. A 97% of nurses reported their NICU employs a specific physiologic assessment policy during PRBC transfusions. The two most common infusion sites used are (99%) peripheral IV as preferred and an umbilical venous catheter (74.5%) as next best option.Conclusion: This study reveals inconsistencies in PRBC transfusion practices in US NICUs. Vast inconsistencies were shown in warming transfusions and in feeding practices surrounding PRBC transfusions. Future research should examine these variations in PRBC transfusion practices for any contributions to the relationship of PRBC transfusions and morbidity in preterm infants. A standard guideline should be developed based on the research evidence to guide nurses in administering preterm PRBC transfusions.Keywords: neonate, hypothermia, blood transfusions, survey

Background:. This study aimed to evaluate the long-term results of hallux valgus correction with a distal metatarsal reversed-L (ReveL) osteotomy. Methods:. Eighty-eight patients (131 feet) were evaluated after a mean follow-up of 14.2 years (range, 10 to 18 years). Weight-bearing foot radiographs were analyzed preoperatively, at 6 weeks postoperatively, and at the final follow-up for the following parameters: hallux valgus angle (HVA), intermetatarsal angle (IMA), first metatarsophalangeal joint (MTPJ) congruence angle, sesamoid position, presence of the round sign, and first MTPJ arthritis. The visual analog scale (VAS) and the Foot and Ankle Outcome Score (FAOS) assessed postoperative pain and function. Univariate and multivariable logistic regression analyses identified risk factors for hallux valgus recurrence and an inferior clinical outcome. Results:. All radiographic parameters significantly improved at the 6-week follow-up and the final follow-up (p < 0.001). The recurrence rate (HVA >20°) was 14%. A preoperative HVA of >28° (odds ratio [OR], 9.1; p = 0.02) and a 6-week postoperative HVA of >15° (OR, 4.6; p = 0.03) were independent risk factors for recurrence. At the final follow-up, all FAOS subscales resembled high postoperative function (median, 100 points [range of the interquartile range (IQR), 81 to 100 points]). A preoperative body mass index of >30 kg/m2 was associated with lower FAOS quality of life (QOL) (p = 0.04), and postoperative hallux varus was associated with lower FAOS activities of daily living (p = 0.048). Patients with first MTPJ arthritis of grade 2 or higher at the final follow-up had significantly lower FAOS subscales (p < 0.01) except for QOL. Hallux valgus recurrence did not influence the long-term outcome. A symptomatic implant was the main cause of revision (15%). In 94% of cases, the patients were satisfied with the hallux appearance and, in 92% of cases, the patients were satisfied with postoperative pain reduction. Conclusions:. Hallux valgus correction with a ReveL osteotomy led to high long-term satisfaction rates. A preoperative HVA of >28° and a 6-week postoperative HVA of >15° increased the risk of hallux valgus recurrence. First MTPJ arthritis was the leading cause of inferior clinical results, whereas radiographic hallux valgus recurrence had no impact on the clinical results. First MTPJ arthritis at the final follow-up was associated with an inferior clinical outcome, whereas radiographic hallux valgus recurrence had no impact on the long-term clinical results. Level of Evidence:. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Summary:. Cryptocurrency offers a decentralized alternative to traditional financial systems, facilitating peer-to-peer transactions with minimal fees and heightened security. It also transformed into a financial asset similar to gold. Despite its volatile valuation, recent developments, such as the approval of Bitcoin exchange-traded funds by the Securities and Exchange Commission, underscore its evolving role as an investment opportunity. Plastic surgery has increasingly embraced cryptocurrency as a form of payment, leveraging its speed, security, and privacy benefits. However, alongside its potential advantages, risks such as volatility, irreversibility of transactions, and regulatory uncertainties warrant careful consideration. Moving forward, the integration of blockchain technology and cryptocurrency is poised to revolutionize various aspects of plastic surgery, from patient privacy to postoperative monitoring devices, necessitating a proactive approach from surgeons to navigate this evolving landscape. This article explores the intersection of cryptocurrency and plastic surgery, delving into its current applications, risks, investment potential, and future prospects.

Summary:. Integration of artificial intelligence (AI), specifically with natural language processing and machine learning, holds tremendous potential to enhance both clinical practices and administrative workflows within plastic surgery. AI has been applied to various aspects of patient care in plastic surgery, including postoperative free flap monitoring, evaluating preoperative risk assessments, and analyzing clinical documentation. Previous studies have demonstrated the ability to interpret current procedural terminology codes from clinical documentation using natural language processing. Various automated medical billing companies have used AI to improve the revenue management cycle at hospitals nationwide. Additionally, AI has been piloted by insurance companies to streamline the prior authorization process. AI implementation holds potential to enhance billing practices and maximize healthcare revenue for practicing physicians.

Surgeons must be confident that the instruments they use do not pose risk of infection to patients due to bioburden or contamination. Despite this importance, surgeons are not necessarily aware of the steps required to ensure that an instrument has been properly sterilized, processed, and prepared for the next operation. At the end of an operation, instruments must be transported to the sterile processing unit. There, instruments are decontaminated before being sterilized by heat, chemical, or radiation-based methods. Following this, they are stored before being brought back into use. This review highlights the intricacies of the processing of surgical instruments at the conclusion of an operation so that they are ready for the next one.

Background: Autologous matrix-induced chondrogenesis (AMIC) for the treatment of osteochondral lesions of the talus (OLT) results in favorable clinical outcomes, yet high reoperation rates. The aim of this study was to report and analyze typical complications and their risk factors after AMIC for OLT. Methods: A total of 127 consecutive patients with 130 AMIC procedures for OLT were retrospectively assessed. All AMIC procedures were performed in an open fashion with 106 (81.5%) cases requiring a malleolar osteotomy (OT) to access the OLT. Seventy-one patients (54.6%) underwent subsequent surgery. These cases were evaluated at a mean follow-up of 3.1 years (±2.5) for complications reviewing postoperative imaging and intraoperative findings during revision surgery. Six patients (8.5%) were lost to follow-up. Regression model analysis was conducted to identify factors that were associated with AMIC-related complications. Results: Among the 65 (50%) patients who required revision surgery, 18 patients (28%) demonstrated AMIC-related complications with deep fissuring (83%) and thinning (17%) of the AMIC graft. Conversely, 47 patients (72%) underwent subsequent surgery due to AMIC-unrelated reasons including isolated removal of symptomatic hardware (n = 17) and surgery addressing concomitant pathologies with (n = 25) and without hardware removal (n = 5). Previous prior cartilage repair surgery was significantly associated with AMIC graft-associated complications in patients undergoing revision surgery ( P = .0023). Among age, body mass index, defect size, smoking, and bone grafting, smoking was the only factor showing statistical significance with an odds ratio of 3.7 (95% CI 1.24, 10.9; P = .019) to undergo revision surgery due to graft-related complications, when adjusted for previous cartilage repair surgery. Conclusion: The majority of revision surgeries after AMIC for OLT are unrelated to the performed AMIC graft but frequently address symptomatic hardware and concomitant pathologies. Both smoking and previous cartilage repair surgery seem to significantly increase the risk of undergoing revision surgery due to AMIC-related complications. Level of evidence: Level IV, case series.

Background:. The increasing patient demand for cosmetic surgeries and minimally invasive procedures has encouraged physicians without aesthetic surgery training accredited by the American Board of Medical Specialties to provide these services. This systematic review aims to determine the rate of out-of-scope practice in medical malpractice lawsuits involving cosmetic surgery or minimally invasive procedures performed by nonplastic surgeons. Methods:. Our systematic review of the Westlaw legal database from 1979 to 2022 included 64 malpractice cases. Inclusion criteria were cosmetic surgeries or minimally invasive procedures in medical malpractice lawsuits not involving board-certified plastic surgeons. Out-of-scope was defined using the procedural competencies established by the American Council for Graduate Medical Education, the Commission on Dental Accreditation, and the Council of Podiatric Medical Education. Data on legal proceedings, provider credentials and board certification, surgical interventions, and legal outcomes were collected. Results:. The majority of malpractice cases involving cosmetic surgeries or minimally invasive procedures occurred when providers were practicing out of scope (N = 34; 55.7%). The verdict was ruled in favor of the plaintiff (patient) in 34.4% of cases. Out-of-scope practice occurred most in family/internal medicine, no board certification, and obstetrics/gynecology (N = 4, N = 4, and N = 3, respectively). The most common allegation was permanent injury or disfigurement (N = 21; 21.4%). Plastic surgeons provided expert testimony 44.0% of the time. Conclusion:. Our review of the Westlaw legal database suggests that the majority of nonplastic surgeon cosmetic malpractice cases may occur in the setting of out-of-scope practice.

Category: Sports Introduction/Purpose: Achilles tendon tendinopathy is a common problem in our daily practice. The initial therapy consists of conservative treatment and usually leads to a reduction of pain. In some cases though, there is need for surgical treatment. The most common procedure is debridement of the tendon. If there is advanced damage of the tendon, a flexor hallucis longus (FHL) transfer may be indicated. In the current literature, there is a lack of hard criteria about the indications for such a transfer. Methods: We searched our radiologic database from the years 2016 and 2017 for magnetic resonance imaging (MRI) scans of the Achilles tendon. 60 patients were included in a tendinopathy group and 60 patients in a control group with no signs of tendinopathy. Inclusion criteria were severe tendinopathy for the tendinopathy group and a normal Achilles tendon for the control group. Exclusion criteria were other relevant morphologic changes or history of relevant surgery of the lower limb. Axial MRI scans were analyzed on a level of 4-5 centimeters above the ankle joint. The area of triceps surae (TS) and FHL were measured as well as the diameter of TS and an oblique diameter of FHL (from the medial corner of the fibula to the posteromedial corner of the FHL muscle). Then, quotients of the area of the FHL/TS and diameter of the FHL/TS were built and interobserver agreement was analyzed. Results: The quotients for area and for diameter of the FHL/TS showed significantly (p

Category: Hindfoot Introduction/Purpose: Different factors are well known influencing the development of adult acquired flatfoot (AAF) deformity. So far less attention was paid to the lateral ligament complex. The idea that the anterior talofibular ligament (ATFL) probably influences AAF could be obvious concerning its anatomical course. Goal of this study is to assess the influence of ATFL on AAF and on operative AAF correction by lateral calcaneal. Methods: We reviewed all patients that undergone lateral calcaneal lengthening in AAF from 01/01/2008 to 07/31/2018 in our clinic. Patients were grouped in patients with intact ATFL and in those with injured ligament. Two independent readers performed assessment of common radiographic flatfoot parameters in preoperative and postoperative radiographs. Results: Statistical significant difference between two groups could be observed for preoperative talonavicular uncoverage angle (p=0.018) and talocalcaneal angle (p=0.032), with more severe AAF in patients with injured ATFL. The other common radiographic parameters showed no significant difference, although a tendency to a more severe AAF could be observed within the group with damaged ATFL. No difference could be observed in surgical outcome or consistency after lateral calcaneal lengthening between two groups. Conclusion: ATFL seems to take impact in AAF concerning talonavicular uncoverage angle and talocalcaneal angle. In patients undergoing lateral calcaneal lengthening the integrity of the ligament seems not to influence the degree of correction or the consistency of the postoperative result.

Category: Hindfoot Introduction/Purpose: The treatment of hindfeet infections with a two-stage revision surgery using an antibiotic-loaded cement spacer is an established treatment strategy. If the soft tissue situation is critical or if patients do have severe comorbidities, the use of a one-stage procedure, using an Ilizarov ringfixator to perform the arthrodesis is also an option. We wanted to compare the outcome of patients who either received the two-stage revision or the one-stage procedure. The purpose of the study was to determine the likelihood of infection control and radiological consolidation of the arthrodesis after either two-stage or one-stage revision in patients with hindfoot infection, as defined by the Musculoskeletal Infection Society PJI criteria. The postoperative AOFAS score was used to measure the clinical outcome. Methods: Between 1995 and 2015, we treated 12 patients with a two-stage procedure using an antibiotic-loaded cement spacer, followed by antibiotic therapy. The second stage consisted of a hindfoot arthrodesis. Of those, 7 were available for review at a minimum of 24 months. 3 were excluded because they were deceased (due to old age). Two moved abroad, leaving 7 patients for analysis. During the same time period we treated 13 patients with a one-stage hindfoot arthrodesis using an Ilizarov ringfixator. Of those, 10 were available for review at a minimum of 24 months. 2 were excluded because they were deceased due to old age, leaving 10 patients for analysis. The primary outcome included the proportion of patients achieving infection control, defined as the absence of the Musculoskeletal Infection Society PJI criteria. Radiological consolidation on standard foot X-rays was also determined. The clinical outcome was assessed with the AOFAS hindfoot score. Results: Successful infection control in the two-stage revision group was achieved in 6 out of 7 patients (86%). One patient achieved infection control only after a below-knee amputation. The mean AOFAS score at the latest follow-up was 75. Radiological consolidation was achieved in 70% (5 out of 7, with one patient needing an amputation for infection control). In the Ilizarov-group, successful infection control was achieved in 9 out of 10 patients (90%). One patient achieved infection control only after a below-knee amputation. The mean AOFAS score at the latest follow-up was 70. Radiological consolidation was achieved in 80% (8 out of 10, with one patient needing an amputation for infection control). Conclusion: A one-stage arthrodesis using an Ilizarov ringfixator for infection control in infected hindfeet leads to comparable infection control and radiological consolidation as the established two-stage procedure with an antibiotic-loaded cement spacer. The clinical outcome, measured by the AOFAS hindfoot score, is also comparable in both groups. The one-stage procedure using an Ilizarov ringfixator should therefore be considered as a treatment option, when soft tissues or comorbidities do not allow a two-stage procedure. It is an option to avoid a below-knee amputation in those patients.

In older persons, the origin of malnutrition is often multifactorial with a multitude of factors involved. Presently, a common understanding about potential causes and their mode of action is lacking, and a consensus on the theoretical framework on the etiology of malnutrition does not exist. Within the European Knowledge Hub “Malnutrition in the Elderly (MaNuEL),” a model of “ D eterminants o f M alnutrition in A ged P ersons” (DoMAP) was developed in a multistage consensus process with live meetings and written feedback (modified Delphi process) by a multiprofessional group of 33 experts in geriatric nutrition. DoMAP consists of three triangle-shaped levels with malnutrition in the center, surrounded by the three principal conditions through which malnutrition develops in the innermost level: low intake, high requirements, and impaired nutrient bioavailability. The middle level consists of factors directly causing one of these conditions, and the outermost level contains factors indirectly causing one of the three conditions through the direct factors. The DoMAP model may contribute to a common understanding about the multitude of factors involved in the etiology of malnutrition, and about potential causative mechanisms. It may serve as basis for future research and may also be helpful in clinical routine to identify persons at increased risk of malnutrition.

Category: Bunion Introduction/Purpose: An optimal osteotomy angle can avoid shortening of the first metatarsal bone after hallux valgus surgery and therefore reduce the risk of transfer-metatarsalgia. Up to date the osteotomy is performed free-hand without guidance and is therefore prone to unwanted variability in accuracy. The purpose of the present ex-vivo study was to investigate whether overlaying a hologram (augmented reality, AR) would improve accuracy of the distal osteotomy during hallux valgus surgery. Methods: A polyamide foot skeleton was constructed based a CT scan of a cadaveric foot and covered with medical silicon soft tissue. Three different polyamide first metatarsals were inserted to simulate a light, moderate and severe hallux valgus deformity. Distal Osteotomies of the first metatarsals were performed by two surgeons with different levels of surgical experience each with (AR, n=15x2) or without (controls, n=15x2) overlay of a hologram depicting an angle of osteotomy perpendicular to the second metatarsal in the transverse plane. Subsequently, the deviation to the plumb line of the second metatarsal in the transverse plane of all 60 osteotomies angles were optically measured and statistically analyzed. Results: Overall, the AR-guided osteotomies were more accurate (4.9 ± 4.2°) compared to the freehand cuts (6.7± 6.1°) by tendency (p=0.2). However, while the inexperienced surgeon performed more accurate osteotomies with AR with a mean angle of 6.4± 3.5° compared to freehand 10.5 ± 5.5° (p=0.02), no significant difference was noticed for the experienced surgeon with an osteotomy angle of around 3° in both cases. Conclusion: This pilot-study suggests that augmented reality guided osteotomies can potentially improve accuracy during hallux valgus surgery, particularly for less experienced surgeons. However, clinical studies are needed to investigate the clinical benefit of augmented reality in hallux valgus surgery.

Category: Hindfoot Introduction/Purpose: Swelling and pain are common after foot and ankle procedures. We hypothesized that compressive stockings (CS) treatment after hindfoot surgery would positively influence patient outcomes. Methods: We undertook this randomized controlled trial in 87 consecutive patients to analyze the clinical effect of CS after hindfoot and ankle surgery and evaluate CS-wearing compliance using sensors that were implanted into CS. Ankle swelling, pain status, quality of life (SF-36 score), and the American Orthopaedic Foot & Ankle Score (AOFAS) were set as the primary end points. The CS wearing time in hours and percentage were investigated as the secondary end points. All participants with CS (group I) were informed about the implanted sensor after the CS were taken off. A subgroup analysis of group I was performed to detect differences between patients with high vs low compliance. Results: At 12 weeks, the results of ankle swelling (mean 234 mm in group I and 232 mm in group II), pain in the visual analog scale (1.7 group I vs 1.9 in group II), the SF-36 score (38 points in group I vs 30 points in group II), and the AOFAS score (a mean of 76 points in both groups) showed no statistical differences between the 2 groups. The mean wearing time was 136 (range, 0-470) hours, which corresponds to a compliance rate of 65%. Sixteen participants had high compliance (>80%, >170 hours), and 21 patients had low or noncompliance. The clinical results of patients with high wearing compliance were not significantly better compared to the results of patients with low compliance. Conclusion: CS therapy after ankle and hindfoot surgery was associated with a low wearing compliance and did not influence ankle swelling, function, pain, and the quality of life compared to the control group. Furthermore, the clinical results of patients with high compliance were not better compared to the results of patients with low or noncompliance wearing behavior.

Category: Midfoot/Forefoot Introduction/Purpose: Recent studies have shown that Hallux valgus deformity can lead to transfermetatarsalgia due to an impairment and relative shortening of the first ray. During ReveL osteotomy the relative shortening of the MT I is not addressed. Furthermore, a posterior deviation of the osteotomy angle results in additional iatrogenic shortening of the MT I and might favor postoperative transfermetatarsalgia. Methods: A 3-dimensional model of a foot was obtained from CT scans of a cadaveric foot. The MT I of the 3-dimensional model was then pivoted medially to simulate a severe hallux valgus deformity of an intermetatarsal angle (IMA) of 18° and an intermediate hallux valgus deformity of an IMA of 13°. A ReveL operation was simulated to correct the IMA to 8° for the severe and the intermediate Hallux valgus. Therefore the osteotomy angle in the coronal plane (f=0) was chosen perpendicular to the axis of the second metatarsalia. Afterwards the length of MT I was measured. This procedure was repeated for an posterior altered osteotomy angle (f = 5°,10°, 15° and 20°). Results: The change in MT I length resulting from an osteotomy perpendicular to the axis of MT II was 0.6 mm for a severe hallux valgus (IMA correction from 18° to IMA 8°) and 0.3 mm for a moderate hallux valgus (IMA 13° to IMA 8°). A posterior deviation of the osteotomy angle led to additional shortening (max. 2.9 mm) with a total shortening of up to 3.5 mm (Figure 3). To avoid any shortening of MT I an osteotomy slightly pointing anterior (negative f) of 3.5° (IMA change of 10°) and 3° (IMA change of 5°) was found. Conclusion: ReveL procedure led only to a maximum shortening of 3.5 mm for a posterior deviation of 20°. Considering recently described MT I length cut off values of 2-3 mm for avoiding transfermetatarsalgia the osteotomy should be performed within an anterior directed cut angle of 4° and a posterior directed cut angle of 10° for the correction of a severe hallux valgus. However, further studies are needed to investigate the clinical impact of our findings.

Category: Ankle Arthritis Introduction/Purpose: Hemophilia is a rare hematological disease associated with spontaneous joint hemorrhaging causing hemophilic arthropathy. Symptoms comprise joint pain and deformity, paired with loss of function. In the presence of advanced joint deterioration, therapeutic options are confined to either arthroplasty or arthrodesis. For the ankle, the latter is still referred to as the procedure of choice. However - in light of its capacity to reduce pain while preserving ankle motion - total ankle replacement (TAR) has recently gained acceptance as an alternative. The aim of this study was to investigate the mid- to long-term results of TAR in hemophilic ankle arthropathy. Methods: Seventeen TARs were implanted between 1998 and 2012 (mean age: 43 years). Preoperative demographic and disease specific data, complications and revision surgeries were recorded. With a mean follow-up of 9.3 years (range, 2.2-17.8) implant survival was estimated using Kaplan-Meier analysis. Follow-up assessment of 12 TARs was performed after 9.6 years (5 lost to follow-up). Satisfaction and pain scales, the AOFAS hindfoot-score, and the SF-36 were obtained to assess clinical outcome. Radiographic evaluation of pre- and follow-up radiographs was conducted. Results: Three cases (17.6%) had undergone TAR removal secondary to loosening at an average interval of 7.5 years. The estimated implant survival was 94% at 5, 85% at 10, and 70% at 15 years (95% CI, 11.9-17.7). The mean estimated implant survival was 14.77 years (95% CI, 11.9-17.7). The mean level of satisfaction was 76%, and of pain 2/10 (VAS). ROM had increased significantly (p=0.037). The SF-36 summary scores were comparable to those of a matched standard population. The AOFAS hindfoot-score averaged 81/100 points. Conclusion: TAR is a viable treatment option for advanced hemophilic ankle arthropathy. Based on the herein presented follow- up, implant survival compares to that of non-hemophilic populations. Clinical mid- to long-term results are favorable. However, the majority of follow-up radiographs revealed component loosening and/or periprosthetic lucency. Considering the study population’s young age and specific risk factors, need for revision surgery secondary to symptomatic component loosening may arise.

Category: Ankle, Hindfoot, Trauma Introduction/Purpose: Lateral talar process fractures (LTPF) constitute 15% of ankle injuries in snowboarders. They are often misdiagnosed on conventional radiographs, which are also susceptible to rotational malpositioning due to pain. A positive V sign is an interruption of the contour of the lateral talar process. It has been suggested to be pathognomonic for LTPF. However, there are very few studies about this topic. The objectives were to study whether the V sign is useful in diagnosing LTPF. Methods: In an experimental study, two investigators evaluated lateral radiographs (n=108) of high resolution, solid foam, radiopaque distal foot and ankle models. Two other investigators, who obtained the radiographs, defined the gold standard. Four different models (no fracture, type A, B, or C fractures according to Hawkins) and three varying ankle joint positions (0°, 20°, and 40° of inversion, plantar flexion, and internal rotation) were the independent variables. The correct detection of a V sign on lateral radiographs (Figure 2 showing a positive V sign on a lateral radiograph in a type B LTPF) was the primary dependent variable and the detection of the fracture type and uncertainty in making this decision were the secondary dependent variables. The chosen study size surpassed the sample size calculation. The chi-squared test was used for categorical data. Results: There were fair interobserver agreements on the V sign and fracture types (kappa coefficient [k]=0.35, 95% confidence interval [CI] 0.18-0.53, p

Background: Breast reconstruction often requires multiple surgeries, which demands additional expense and time and is often contrary to the patient’s expectation. The aim of this study was to review the number of operations that were needed for completion of breast reconstruction and to determine patient and clinical factors that influenced this number. Methods: We retrospectively reviewed the medical records of 254 cases of breast reconstructions (in 185 patients) that were performed between February 2005 and August 2009. We investigated the numbers of operations that were performed for individual case of breast reconstruction and analyzed the influence of variable factors. The purpose of the additional operations was also analyzed. Results: The mean number of operations per breast was 2.37 (range, 1–9). The mean number of operations for mound creation was 2.24. Factors associated with an increased number of operation were use of an implant, contralateral symmetrization, complications, and nipple reconstruction. Considering the reconstruction method, either the use of a primary implant or the use of free abdominal tissue transfer demonstrated fewer surgeries than the use of an expander implant, and the number of operations using free transverse rectus abdominis musculocutaneous or deep inferior epigastric perforator flaps was less than the number of operations using pedicled transverse rectus abdominis musculocutaneous flaps. Conclusions: These data will aid in planning breast reconstruction surgery and will enable patients to be more informed regarding the likelihood of multiple surgeries.

Background: Metatarsal pronation has been claimed to be a risk factor for hallux valgus recurrence. A rounded shape of the lateral aspect of the first metatarsal head has been identified as a sign of persistent metatarsal pronation after hallux valgus correction. This study investigated the derotational effect of a reversed L-shaped (ReveL) osteotomy combined with a lateral release to correct metatarsal pronation. The primary hypothesis was that most cases showing a positive round sign are corrected by rebalancing the metatarsal-sesamoid complex. We further assumed that the inability to correct the round sign might be a risk factor for hallux valgus recurrence. Methods: We retrospectively evaluated 266 cases treated with a ReveL osteotomy for hallux valgus deformity. The radiologic measurements were performed on weightbearing foot radiographs preoperatively, at an early follow-up (median, 6.2 weeks), and the most recent follow-up (median, 13 months). Univariate and multivariate logistic regression analyses identified risk factors for hallux valgus recurrence (hallux valgus angle [HVA] ≥ 20 degrees). Results: A preoperative positive radiographic round sign was present in 40.2% of the cases, of which 58.9% turned negative after the ReveL osteotomy ( P < .001). Hallux valgus recurred in 8.6%. Risk factors for recurrence were a preoperative HVA >30 degrees (odds ratio [OR] = 5.3, P < .001), metatarsus adductus (OR = 4.0, P = .004), preoperative positive round sign (OR = 3.3, P = .02), postoperative HVA >15 degrees (OR = 74.9; P < .001), and postoperative positive round sign (OR = 5.3, P = .008). Cases with a positive round sign at the most recent follow-up had a significantly higher recurrence rate than those with a negative round sign (22.7% vs 5.9%, P < .001). Conclusion: The ReveL osteotomy corrected a positive round sign in 58.9%, suggesting that not all hallux valgus deformities may need proximal derotation to negate the radiographic appearance of the round sign. A positive round sign was found to be an independent risk factor for hallux valgus recurrence. Further 3-dimensional analyses are necessary to better understand the effects and limitations of distal translational osteotomies to correct metatarsal pronation. Level of Evidence: Level IV, case series.

Background: Magnetic resonance imaging (MRI) is commonly used for evaluation of ankle cartilage repair, yet its association with clinical outcome is controversial. This study analyzes the correlation between MRI and clinical outcome after cartilage repair of the talus including bone marrow stimulation, cell-based techniques, as well as restoration with allo- or autografting. Methods: A systematic search was performed in MEDLINE, Embase, and Cochrane Collaboration. Articles were screened for correlation of MRI and clinical outcome. Guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) were used. Chi-square test and regression analysis were performed to identify variables that determine correlation between clinical and radiologic outcome. Results: Of 2687 articles, a total of 43 studies (total 1212 cases) were included with a mean Coleman score of 57 (range, 33-70). Overall, 93% were case series, and 5% were retrospective and 2% prospective cohort studies. Associations between clinical outcome and ≥1 imaging variable were found in 21 studies (49%). Of 24 studies (56%) using the composite magnetic resonance observation of cartilage repair tissue (MOCART) score, 7 (29%) reported a correlation of the composite score with clinical outcome. Defect fill was associated with clinical outcome in 5 studies (12%), and 5 studies (50%) reported a correlation of T2 mapping and clinical outcome. Advanced age, shorter follow-up, and larger study size were associated with established correlation between clinical and radiographic outcome ( P = .021, P = .028, and P = .033). Conclusion: Interpreting MRI in prediction of clinical outcome in ankle cartilage repair remains challenging; however, it seems to hold some value in reflecting clinical outcome in patients with advanced age and/or at a shorter follow-up. Yet, further research is warranted to optimize postoperative MRI protocols and assessments allowing for a more comprehensive repair tissue evaluation, which eventually reflect clinical outcome in patients after cartilage repair of the ankle. Level of Evidence: Level III, systematic review and meta-analysis.

Category: Ankle; Hindfoot; Sports Introduction/Purpose: Autologous matrix-induced chondrogenesis (AMIC) has shown to result in favorable clinical outcome in patients with osteochondral lesions of the talus (OLT). Yet, the influence of ankle instability on cartilage repair of the ankle has still to be determined. This study sought to compare the clinical and radiographic outcome in patients with and without concomitant lateral ligament stabilization (LLS) undergoing AMIC for the treatment of OLT. Methods: This study evaluated AMIC that were implanted in patients for the treatment of symptomatic OLT with and without concomitant ankle instability. Postoperative MRI, Tegner, AOFAS and Cumberland Ankle Instability Tool (CAIT) were obtained at a minimum follow-up of 2 years. A musculoskeletal radiologist scored all grafts according to the MOCART 1 and 2.0 scores. Patients were stratified into two groups based on whether they underwent concomitant LLS for ankle instability. Patients without LLS served as controls. Patients were matched 1:1 for BMI, lesion size, follow-up and age. Results: Twenty-six patients that underwent AMIC with a mean follow-up of 4.2 +- 1.5 years were enrolled in this study (13 with and 13 without concomitant ankle instability). Patients' mean age was 33.4 +- 12.7 years with a BMI averaging 26.2 +- 3.7. Patients with concomitant LLS showed worse clinical outcome measured by AOFAS (85.1 +- 14.4 vs. 96.3 +- 5.8, p=0.034) and Tegner (3.8 +- 1.1 vs. 4.4 +- 2.3, p=0.012). No difference was seen between both groups regarding MOCART 1 and 2.0 scores (p=0.714 and p=0.371, respectively). Additionally, postoperative CAIT and AOFAS significantly correlated in patients that underwent concomitant LLS (r=0.766, p=0.002) with a CAIT score of > 24 (stable ankle joint) resulting in AOFAS scores comparable to scores in patients with isolated AMIC (90.1 +- 11.6 vs. 95.3 +- 6.6; p=0.442). Conclusion: The results of this study suggest a negative influence of ankle instability on the clinical outcome of cartilage repair with AMIC for the treatment of OLT. If postoperative ankle stability is achieved in patients with LLS, however, comparable outcome as seen after isolated AMIC can be expected.

Purpose: Penile inversion vaginoplasty (PIV) is the most common gender affirming genital procedure for transfeminine patients. The purpose of this study was to investigate the impact of tranexamic acid (TXA), an antifibrinolytic, on bleeding and bleeding-related complications in vaginoplasty surgery. Methods: Retrospective chart review was performed on patients undergoing PIV from February 2018 through March 2020 by the senior author (K.G.) at the University of Wisconsin Hospital and Clinics. Patients who received TXA received a combination of topical and intravenous TXA. Data collected includes patient demographics (age, body mass index, race, comorbidities, and tobacco and illicit drug use), intraoperative data (duration of surgery, estimated blood loss, fluid administration, TXA use and dose, and complications), and postoperative data (drain output, complications within 30 days, and revision surgery). Subgroup analysis on the effect of TXA was performed using independent sample t-test. Results: Seventy-four patients were included in this study with 56 patients receiving TXA and 18 patients who had surgery prior to initiation of TXA protocol. There were no thromboembolic events observed in the TXA or the non-TXA group. Ninety percent of all complications were Clavien-Dindo Grade 1 and did not require intervention. There was a significantly lower EBL in the TXA group compared to the no TXA cohort (299.1 ± 64.3 vs. 347.2 ± 84.8, p=0.013). Patients who received TXA had significantly fewer wound related complications than those who did not receive TXA (21.4% vs. 66.7%, p

Category: Ankle Introduction/Purpose: Autologous matrix-induced chondrogenesis (AMIC) has recently become an interesting treatment option for osteochondral lesions of the talus since it combines safety and efficacy with overcoming several drawbacks of other surgical techniques. With AMIC, donor side morbidity of osteochondral autografts is eliminated, two-step procedures like matrix-induced autologous chondrocyte implantation are minimized to a more cost-effective single step and restrictions due to limited availability of osteochondral allografts are resolved. The purpose of this study was to evaluate the therapeutic efficacy of AMIC by analyzing AMIC-repaired osteochondral talar lesions in consecutively treated patients after a minimum follow-up of 2 years. Methods: All patients with an osteochondral lesion of the talus treated with the AMIC technique completing a minimum follow-up of 2 years were enrolled in the study for clinical and radiological follow-up. Patients with additional procedures such as lateral ligament reconstruction or corrective calcaneal osteotomy were excluded. 31 of the 47 eligible patients (28 males, 13 females; mean age at surgery 35.7 (range, 13-75) years); body mass index 27.1+-4.7 kg/m2) could be retrospectively evaluated after a mean follow-up of 4.6 (range, 2.3-7.9) years. The preoperative defect size was 0.9+-0.5 (range 0.4-2.3) cm2. Only two osteochondral lesions were localized laterally. Data analysis included general demographics, the visual analogue scale (VAS) for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) score for ankle function, the Tegner Score for sports activity, and the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system for radiological evaluation. Results: The VAS improved significantly from 6.5+-2.0 preoperatively to 1.5+-2.2 at follow-up (p

Summary:. Fenestrated acellular dermal matrix (ADM) has improved patient outcomes in both direct-to-implant and 2-stage tissue expander/implant breast reconstruction. This technical alteration utilizes optimal fenestration overlap to enhance the breast reconstruction experience. We present a novel, surgeon-designed shaped fenestrated ADM, placed in the recently repopularized prepectoral pocket for anterior coverage of implants in direct-to-implant and 2-stage breast reconstruction. A retrospective review of 10 patients (18 breasts) who underwent direct-to-implant or 2-stage breast reconstruction utilizing fenestrated shaped ADM in the prepectoral plane at a major academic institution in 2016 was conducted. Sixteen breasts (88.9%) underwent direct-to-implant reconstruction, and 2 breasts (11.1%) received tissue expanders. All reconstructions were performed using FlexHD Pliable ADM with surgeon-designed shape and fenestrations. The average implant size was 544.4 cc (±137.2 cc). The average intraoperative tissue expander fill volume measured 450 cc (90% of tissue expander size). The single expander case utilized 1 office fill (day 21) for full expansion. Major complications requiring reoperation within 90 days postoperatively were observed in 22.2% (4 breasts) of reconstructions. Three breasts (16.7%) due to partial mastectomy flap necrosis, 1 breast (5.5%) explantation due to infection. There was no seroma or capsular contracture. Prepectoral reconstruction with shaped fenestrated ADM is safe with high intraoperative fill volumes and facilitates more direct-to-implant reconstructions. Patients undergo fewer postoperative expansions, experience less time to full expansion, and subjectively report less pain. Patients benefit from improved cosmetic outcomes with better shape and no functional loss or animation deformity.

Introduction: Physician assistants (PAs) are subject to high levels of burnout, depressive symptoms, and anxiety, which can negatively impact quality of care and patient outcomes. Learning how to handle stress in the classroom may increase success and engagement in PA programs. The goal of this study was to characterize burnout, depressive symptoms, and anxiety in current PA students and examine the relationship between these factors and work engagement. Methods: This cross-sectional study surveyed PA students ( n = 42) via convenience sampling from eighteen different PA programs across North and South Carolina in October, 2021. Questionnaires included the Utrecht Work Engagement Scale (UWES-17), the Patient Health Questionnaire (PHQ-2), the General Anxiety Disorder scale (GAD-7), and the COVID-19 Anxiety Scale (CIAS). Adjusted linear regression was used to assess associations between the GAD-7, PHQ-2, and CIAS and the three subscales of the UWES-17 (vigor, dedication, and absorption). Results: Students were primarily female (79%), white (79%), second-year students (62%), and had an average body mass index of 21.0 ± 3.9 kg/m 2 . A one-unit increase in the GAD-7 was associated with a decrease in the vigor (β = -0.94, SE = 0.19, p < .01) and dedication (β = -0.42, SE = 0.15, p = .01) subscales. A one-unit increase in the PHQ-2 was associated with a decrease in the vigor subscale (β = -2.94, SE = 0.60, p < .01). Conclusions: Recognizing warning signs of declining mental health early among PA school students may be key to increasing resilience, enthusiasm, and concentration, which may enhance school/work engagement. More work is needed to elucidate potential intervention targets to increase school/work engagement in PA students., 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.

The goal of this study was to examine the relationship between diet quality, nutrients, and health outcomes among participants in the Dietary Guidelines: 3 Diets study (3-group randomized 12-week intervention; African American; Southeastern virtual teaching kitchen). Participants (n = 63; ages 18-65 y, BMI 25-49.9 kg/m 2 ) were randomized to the Healthy U.S. (H-US), Mediterranean (Med), or Vegetarian (Veg) groups. Hypotheses tested included (1) that the more plant-based diet patterns (Veg and Med) would have greater improvements in all diet quality indices (Dietary Approaches to Stop Hypertension (DASH), Dietary Inflammatory Index (DII), alternate Mediterranean Diet Index (aMED), healthy Plant-based Dietary Index (hPDI) assessed via three dietary recalls) as compared to the H-US pattern and (2) that each index would separately predict changes in weight loss, hemoglobin A1c (HbA1c), and blood pressure (BP). None of the group-by-time interactions for any of the diet indices were significant. Compared to the H-US group, Veg participants had greater increases in fiber (difference between groups 5.72 ± 2.10 5 g/day; P = .01), riboflavin (0.38 ± 0.19 mg/day; P = .05), and folate (87.39 ± 40.36 mcg/day; P = .03). For every one-point increase in hPDI, there was a 1.62 ± 0.58 mmHg decrease in systolic BP, for every one-point increase in aMED there was a 1.45 ± 0.70 mmHg decrease in diastolic BP, and for every one-point increase in hPDI, there was a 1.15 ± 0.38 mmHg decrease in diastolic BP. Findings indicate that there is significant overlap in the dietary recommendations of the three dietary patterns presented in the USDG and similarities in how African American adults adopt those diet patterns. Clinical Trials registry at clinicaltrials.gov:NCT04981847., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To examine factors associated with weight status underestimation and the relationship between weight status underestimation and weight loss as a weight management goal among adults living in the rural South., Methods: An anonymous survey was distributed at six primary care clinics and two churches in rural, South Carolina counties. Weight status underestimation was determined based on the difference between perceived weight status using standard body mass index (BMI) categories (underweight, normal weight, overweight, and obese) and BMI category from self-reported height and weight. Participants reported whether their weight management goal was to lose, maintain, or gain weight. Chi-square and binary logistic regressions were used for data analysis., Findings: A total of 185 respondents (76% female) at least partially completed the survey. Nearly 60% underestimated their weight status. Increasing BMI was associated with higher odds of weight status underestimation (OR: 1.10, 95%: 1.04, 1.15) and perceptions of being in fair or poor health was associated with lower odds of weight status underestimation relative to perceiving health as good or better (OR: 0.21, 95% CI: 0.06, 0.66). Among those with overweight and obesity, the association between underestimating weight status and having weight loss as a weight management goal was strong but not statistically significant (OR: 0.20, 95% CI: 0.04, 1.04)., Conclusions: Underestimating weight status was common among adults in the rural US South and was related to BMI and health status. Research is needed to determine if improving the accuracy of weight perceptions can promote weight management in the rural South., (© 2024 The Author(s). The Journal of Rural Health published by Wiley Periodicals LLC on behalf of National Rural Health Association.)

Sleep has strong inflammatory underpinnings and diet is one of the primary determinants of systemic inflammation. A systematic literature review was conducted to synthesize current research associating dietary inflammatory potential, as measured by the dietary inflammatory index (DII®) or the energy-adjusted DII (E-DII™) and sleep quality and duration. The National Library of Medicine (Medline), Web of Science, and PsycInfo databases were searched through March 2023. Studies must have used the DII/E-DII as the independent variable and sleep outcomes as dependent variables. Study characteristics, based on STROBE guidelines, were scored based on the presence of the recommendation. Out of the initial 14 studies identified, a total of 12 studies were included for data synthesis. In all 12 studies, more anti-inflammatory diets (i.e., low DII/E-DII scores) were associated with better sleep in at least one sleep domain (most often sleep efficiency and wake-after-sleep-onset). Among those studies with more rigorous diet and sleep measurements, such as dietary recalls and actigraphy, associations between DII/E-DII and sleep outcomes were stronger and more consistent compared to studies using primarily subjective assessments. More rigorous measurement of diet and sleep, especially those relating to sleep stage structure, should be considered in future studies with prospective designs., Competing Interests: Declaration of competing interest Dr. James Hébert owns controlling interest in Connecting Health Innovations LLC (CHI), a company licensing the right to his invention of the Dietary Inflammatory Index (DII®) from the University of South Carolina in order to develop computer and smart phone applications for patient counseling and dietary intervention in clinical settings., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background and Aims: Research into the relationship between an Energy-adjusted Diet-Inflammatory Index (E-DII) and a wider health-related biomarkers profile is limited. Much of the existing evidence centers on traditional metabolic biomarkers in populations with chronic diseases, with scarce data on healthy individuals. Thus, this study aims to investigate the association between an E-DII score and 30 biomarkers spanning metabolic health, endocrine, bone health, liver function, cardiovascular, and renal functions, in healthy individuals., Methods and Results: 66,978 healthy UK Biobank participants, the overall mean age was 55.3 (7.9) years were included in this cross-sectional study. E-DII scores, based on 18 food parameters, were categorised as anti-inflammatory (E-DII < -1), neutral (-1 to 1), and pro-inflammatory (>1). Regression analyses, adjusted for confounding factors, were conducted to investigate the association of 30 biomarkers with E-DII. Compared to those with an anti-inflammatory diet, individuals with a pro-inflammatory diet had increased levels of 16 biomarkers, including six cardiometabolic, five liver, and four renal markers. The concentration difference ranged from 0.27 SD for creatinine to 0.03 SD for total cholesterol. Conversely, those on a pro-inflammatory diet had decreased concentrations in six biomarkers, including two for endocrine and cardiometabolic. The association range varied from -0.04 for IGF-1 to -0.23 for SHBG., Conclusion: This study highlighted that a pro-inflammatory diet was associated with an adverse profile of biomarkers linked to cardiometabolic health, endocrine, liver function, and renal health., Competing Interests: Conflict of interest The authors have no conflict of interest to declare., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

This study analyzed the overall quality of the diet using predefined indices, including the Healthy Eating Index-2015 (HEI-2015), the Alternative Healthy Eating Index-2010 (AHEI-2010), the alternate Mediterranean Diet (aMED) score, the Dietary Approaches to Stop Hypertension (DASH) score, and the Dietary Inflammatory Index (DII ® ), to explore their association with the risk of bladder cancer in the Multiethnic Cohort Study. Data were taken from 186,979 African American, Japanese American, Latino, Native Hawaiian, and non-Hispanic White participants aged 45-75 years, with 1152 incident cases of invasive bladder cancer during a mean follow-up period of 19.2 ± 6.6 years. Cox models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) with comprehensive adjustment for smoking. Comparing the highest vs. lowest diet quality score quintile, HRs (95% CIs) in men was 1.08 (0.86-1.36) for HEI-2015, 1.05 (0.84-1.30) for AHEI-2010, 1.01 (0.80-1.27) for aMED, 1.13 (0.90-1.41) for DASH, and 0.96 (0.76-1.21) for DII ® , whereas the corresponding HRs for women were 0.75 (0.53-1.07), 0.64 (0.45-0.92), 0.60 (0.40-0.88), 0.66 (0.46-0.95), and 0.63 (0.43-0.90) with all p values for trend <0.05. The inverse association found in women did not vary by smoking status or race and ethnicity. Our findings suggest that adopting high-quality diets may reduce the risk of invasive bladder cancer among women in a multiethnic population.

Background & Aims: We examined the dietary inflammatory potential in patients who underwent liver transplantation (LTx), associated factors and its relationship with clinical outcomes ten years after the initial evaluation., Methods: Dietary Inflammatory Index (DII®) scores were generated from data derived from the 24-h recall in 108 patients., Results: Patients with higher DII scores (highest tertile), indicating a pro-inflammatory diet, had significantly higher serum LDL cholesterol (108.0 vs 78.2 mg/dL, p = <0.01) at the initial evaluation. However, DII scores did not significantly predict the occurrence of clinical outcomes after ten years of follow-up. Patient age was predictive of neoplasia (OR:1.05 95% CI:1.00-1.11; p = 0.03). Higher BMI at the initial evaluation was associated with steatosis (OR:1.51; 95% CI:1.29-1.77; p < 0.01), and smoking history was associated with the occurrence of cardiovascular events (OR:7.71; 95% CI:1.53-38.79; p = 0.01)., Conclusions: A pro-inflammatory diet was associated with higher serum LDL cholesterol in the initial evaluation but may not be strongly related to clinical outcomes during long-term follow-up., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest. However, Dr. James R. Hébert discloses that he owns controlling interest in Connecting Health Innovations LLC (CHI), a company that has licensed the right to his invention of the dietary inflammatory index (DII®) from the University of South Carolina in order to develop computer and smart phone applications for patient counseling and dietary intervention in clinical settings. Dr. Michael Wirth has an interest in the DII and Longgang Zhao is an employee of CHI. The subject matter of this paper will not have any direct bearing on the work of CHI, nor has CHI activities exerted any influence on this project., (Copyright © 2024 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Objective  The association between sleep quality and overall health has been extensively examined. However, few studies have investigated the relationship between sleep and the inflammatory potential of the diet. Thus, the purpose of the present study was to explore the association between the scores on the Energy-Adjusted Dietary Inflammatory Index (E-DII) and sleep quality in Lebanese university students. Materials and Methods  We conducted a cross-sectional study with students attending the Tripoli campus of Beirut Arab University. A total of 270 students aged between 17 and 25 years were randomly selected. All students filled out a multicomponent questionnaire that included an assessment of their sleep quality using the Pittsburg Sleep Quality Index, and of their physical activity level using the short version of the International Physical Activity Questionnaire. The scores on the E-DII were calculated based on a validated food frequency questionnaire. Results  Individuals in the highest (most proinflammatory) quartile of the E-DII were at an increased risk of having poor overall sleep quality compared with the lowest quartile (odds ratio [OR] = 2.86; 95% confidence interval [95%CI]: 1.27-6.44). Regarding the individual domains of sleep quality, subjects in quartiles 3 and 4 of the E-DII were at an increased risk of having poor sleep efficiency compared with those in quartile 1 (OR = 2.49; 95%CI: 1.12-5.54; and OR = 2.52, 95%CI: 1.13-5.62 respectively). However, individuals in quartile 3 were at a reduced risk of having daytime dysfunction compared with those in the lowest quartile (OR = 0.44; 95%CI: 0.23-0.83). Conclusion  The inflammatory potential of the diet seems to be related to sleep quality in our sample of Lebanese university students. Future prospective studies are required to further explore this association., Competing Interests: Conflict of Interests Dr. James R. Hébert wishes to disclose that he owns controlling interest in Connecting Health Innovations LLC (CHI), a company that has licensed the right to his invention of the Dietary Inflammatory Index (DII) from the University of South Carolina to develop computer and smartphone applications for patient counseling and dietary intervention in clinical settings. Connecting Health Innovations LLC owns exclusive rights to the E-DIITM. The subject matter of the present paper will not have any direct bearing on that work, nor has that activity exerted any influence on this project. The authors have no other potential competing interests to disclose., (Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Background: Individuals with ulcerative colitis (UC) seek complementary treatment methods, including diet and physical activity, to manage the burden of living with UC. This study examined associations between diet-associated inflammation, physical activity (PA), and UC-related health outcomes., Methods: Data were obtained from 2052 IBD Partners e-cohort participants with UC. To quantify the inflammatory potential of food intake, dietary data were converted into Dietary Inflammatory Index (DII) and energy adjusted (E-DII) scores. Physical activity data were collected using the Godin-Shephard Leisure Time Activity Index. Outcome variables included the Simple Clinical Colitis Activity Index, Short Inflammatory Bowel Disease Questionnaire, and psychosocial PROMIS domains., Results: Higher E-DII scores, as indicator of increased dietary inflammatory potential, were associated with increased disease activity (β = 0.166; P < .001), anxiety (β = 0.342; P = .006), depression (β = 0.408; P = .004), fatigue (β = 0.386; P = .005), sleep disturbance (β = 0.339; P = .003), and decreased social satisfaction (β = -0.370; P = .004) and quality of life (β = -0.056; P < .001). Physical activity was inversely associated with disease activity (β = -0.108; P < .001), anxiety (β = -0.025; P = .001), depression (β = -0.025; P = .001), fatigue (β = -0.058; P < .001), and sleep disturbance (β = -0.019; P = .008), while positively associated with social satisfaction (β = 0.063; P < .001) and quality of life (β = 0.005; P < .001). Beneficial effects were generally greater for strenuous PA intensity., Conclusions: An anti-inflammatory diet and increased PA are associated with decreased disease activity, anxiety symptoms, depression symptoms, and fatigue, and associated with improved quality of life, sleep, and social satisfaction for patients with UC. Such modalities may reduce the daily burden of illness and aid in managing systemic and localized inflammation associated with UC., (© The Author(s) 2023. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Physical inactivity is a modifiable behavioral risk factor for breast cancer. Chinese American women have an increased breast cancer incidence and a low prevalence of meeting physical activity (PA) recommendations, yet little is known about their knowledge and experience regarding PA and breast cancer prevention. Given the significant cultural differences between Eastern and Western societies, effective interventions to promote PA among Chinese American women require understanding their knowledge levels regarding PA in breast cancer prevention and their PA experiences through a cultural lens. This qualitative descriptive study used virtual semi-structured individual interviews to explore Chinese American women's knowledge and perception of PA, their understanding of the role of PA in breast cancer prevention, and influence of culture and acculturation on PA experience. Twenty-one Chinese American women residing in eight states were interviewed. Using thematic analysis, four themes emerged: A limited appreciation of the preventability of breast cancer, variability in PA perception, Chinese culture norms and lifestyles influencing PA behavior, and the influence of the process of acculturation on PA behavior. Chinese American women had a limited understanding of PA in breast cancer prevention. Chinese culture, lifestyles, and traditional Chinese medicine positively and negatively influence Chinese American women's PA behaviors. When exposed to American culture, Chinese American women tended to adopt new PA behaviors, including increasing leisure-time PA while decreasing occupation- and transportation-related PA. Interventions to increase PA and reduce breast cancer risk among Chinese American women should address cultural factors and acculturation along with education and behavioral change strategies., 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.