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STUDY DESIGN: Retrospective review of a prospectively-collected multicenter database. OBJECTIVES: The objective of this study was to determine optimal strategies in terms of focal angular correction and length of proximal extension during revision for PJF. METHODS: 134 patients requiring proximal extension for PJF were analyzed in this study. The correlation between amount of proximal junctional angle (PJA) reduction and recurrence of proximal junctional kyphosis (PJK) and/or PJF was investigated. Following stratification by the degree of PJK correction and the numbers of levels extended proximally, rates of radiographic PJK (PJA >28° & ΔPJA >22°), and recurrent surgery for PJF were reported. RESULTS: Before revision, mean PJA was 27.6° ± 14.6°. Mean number of levels extended was 6.0 ± 3.3. Average PJA reduction was 18.8° ± 18.9°. A correlation between the degree of PJA reduction and rate of recurrent PJK was observed (r = -.222). Recurrent radiographic PJK (0%) and clinical PJF (4.5%) were rare in patients undergoing extension ≥8 levels, regardless of angular correction. Patients with small reductions (30°) and extensions

BACKGROUND: Infection rates in revision total hip arthroplasty are lower when antibiotic loaded cemented stems are utilized. Inspired by this technique, a point-of-care coating of antibiotic-loaded calcium sulfate (CaSO4) was applied to cementless revision stems in aseptic revision and 2nd stage reimplantation total hip arthroplasty. METHODS: One hundred eleven consecutive femoral stems were coated. Just prior to insertion, 10 cc of CaSO4 was mixed with 1 g vancomycin and 240 mg tobramycin with the paste applied to the stem. The results were compared to a matched cohort (N = 104) performed across the previous 5 years. The surgical methods were comparable, but for the stem coating. The study group was followed for a minimum of 3 years. RESULTS: In the study cohort of 111 patients, there were 69 aseptic revisions with one periprosthetic joint infection (PJI) (1.4%) and 42 second-stage reimplantations with 2 PJIs (4.8%). In the control cohort of 104 patients, there were 74 aseptic revisions with one PJI (1.4%) and 30 second-stage reimplantations with 7 PJIs (23.3%). There was no significant reduction in PJI rate in the aseptic revision subgroup (1.4% study vs 1.4% control group), P = 1.000. Antibiotic stem coating reduced PJI rate in the 2nd stage reimplantation subgroup (23.3% control vs 4.8% study group), P = .028. In both groups, there were no cases of aseptic stem loosening. CONCLUSIONS: Point-of-care antibiotic coating of cementless revision femoral stems reduces PJI infection rate in 2nd stage reimplantations only. We theorize that microbes persist in the endosteal cortices after resection and may contribute to infection recurrence.

The Kolovec P-6a/15 Borehole was drilled in the northeast of the town of Domžale (western Slovenia) on the Kolovec hill and 11 core samples were taken from this borehole in the depth range of 22–98 m. The borehole uncovered dolomites and dolomitized limestones of the Triassic. These samples were selected for microfaunal studies. The identified foraminifers make it possible to attribute these rocks to the uppermost part of the Olenekian and the lowermost part of the Anisian and mark the boundary between the stages. This article clarifies the diagnosis of the species Glomospira tenuifistula Ho, 1959, emend. Vuks, nov., Meandrospira (?) dinarica Kochansky-Devidé et Pantić, 1966, emend. Vuks, nov., and Meandrospira (?) insolita (Ho), 1959, emend. Vuks, nov. [ABSTRACT FROM AUTHOR]

Copyright of Retos: Nuevas Perspectivas de Educación Física, Deporte y Recreación is the property of Federacion Espanola de Asociaciones de Docentes de Educacion Fisica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Retos: Nuevas Perspectivas de Educación Física, Deporte y Recreación is the property of Federacion Espanola de Asociaciones de Docentes de Educacion Fisica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Retos: Nuevas Perspectivas de Educación Física, Deporte y Recreación is the property of Federacion Espanola de Asociaciones de Docentes de Educacion Fisica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Predicting the success of a Debridement, Antibiotics, and Implant Retention (DAIR) procedure for periprosthetic joint infection (PJI) for hip and knee joint arthroplasty remains a challenge. A failed DAIR might adversely affect the outcome of any future revision surgery for PJI. Hence, the ability to identify and optimize factors predictive of DAIR success would help target the procedure to the appropriate patient cohort and avoid unnecessary surgery for patients where a DAIR is unlikely to eradicate infection. Methods: A retrospective review of our prospective Bone Infection Group database was performed to identify all patients who underwent a DAIR of their primary or revision hip or knee arthroplasty. All patients had a confirmed PJI as per MSIS 2013 criteria and an outcome according to the MSIS working group outcome-reporting tool. DAIR surgery was then grouped into groups of "successful" or "unsuccessful" outcomes. Results: Sixty-four consecutive patients with an acute PJI underwent a DAIR procedure between 2009 and 2020, with 46 procedures performed for knees and 18 for hips. Treatment was successful in 69% (37 knees and 7 hips). The chance of a successful DAIR was significantly greater if performed at or within one week of symptom onset compared to greater than one-week duration (adjusted odds ratio (OR) 0.11; P = 0.027; 95% CI [0.02–0.78])). For DAIR performed at or within one week of symptom onset, the success rate was 93% for knees and 80% for hips. The chance of a successful DAIR however was not influenced by whether the surgeon was an arthroplasty or non-arthroplasty surgeon (OR 0.28; P = 0.13; 95% CI [0.05–1.48])). Isolated Streptococcus infection had a success rate of 100%. Next came Coagulase-negative Staphylococci (71%) and Methicillin-susceptible Staphylococcus Aureus (65%). Polymicrobial infection had the worst outcome, with a success rate of 40%. Conclusion: In our experience, DAIR surgery performed within one week of symptom onset significantly increased the chance of successful infection eradication. Collaborative work is required to ensure arthroplasty patients can access prompt appropriate surgical decision-making as soon as concerns arise, remove barriers to early assessment and minimise delays to surgery. [ABSTRACT FROM AUTHOR]

Background: Unicompartmental knee arthroplasty (UKA) is a surgical procedure for managing osteoarthritis of one joint compartment, most commonly the medial side. This systematic review investigates the causes of UKA revision. The outcomes of interest were establishing the revision rate, time to revision, and the most common causes of revision in the long- and midterm follow-up. Methods: This study was conducted according to the 2020 PRISMA statement. In October 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the clinical studies investigating the rate and causes of revision in UKA were accessed. Only studies with a minimum of 10 years of follow-up were considered. Results: Data from 56 studies (13,540 patients) were collected. Of them, 65.6% were women. The mean length of the follow-up was 13.1 ± 3.0 years. The mean age of the patients was 65.6 ± 5.6 years, and the mean BMI was 28.5 ± 2.2 kg/m2. Revisions were performed in 8.8% (2641 of 30,140) of implanted UKAs. The mean time to revision was 6.5 ± 2.6 (range, 2.5 to 13.0) years. Conclusion: 8.8% (2641 of 30,140) of UKAs were revised at a mean time of 6.5 ± 2.6 years. Level of evidence: Level IV, systematic review. [ABSTRACT FROM AUTHOR]

This essay puts Persuasion in conversation with psychotherapeutic approaches to Austen and cognitive literary studies (more broadly, approaches that draw on the sciences of mind). Narrative therapy provides a heuristic for Persuasion, accounting for Anne Elliot's recovery from melancholy to achieve a sense of well-being. In line with the goals of narrative therapy, she learns to tell a different story about herself than the one that has oppressed her since her broken engagement. The novel represents the therapeutic elements involved in such reenvisioning, including validation; holding; the availability of alternative, better narratives as models; and awareness of the cultural factors that have contributed to her state of mind. Conversely, narratology accounts for the representation of Anne's experience, showing how literary devices, including embedded narrative, focalization, and voice, convey Anne's transformation from melancholy and passive spinster to active and vital woman who defends her actions and renews her engagement on better terms. This transformation depends not only on interpersonal exchanges but also on her realization that cultural "master narratives" infiltrate our most intimate stories. [ABSTRACT FROM AUTHOR]

Hydrocephalus is a common diagnosis worldwide that is treated with shunts and is associated with potential life-threatening risks of shunt dysfunction and infection. We investigated differences in rates of shunt revisions and infections including various factors in patients with different causes of hydrocephalus. We also studied causes of infections and efficacy of perioperative antibiotic regimens. Our objective was to identify patients at risk of higher revision and infection rates after shunt treatment. We conducted a retrospective single-center cohort study including 728 adult patients who underwent shunt surgery between 2013 and 2019 at our center. Overall revision rate was 20.1%, and infection rate was 4.8%. Infection was detected in 24% of all revisions. The main location for a positive culture was cerebrospinal fluid (67.5%), frequently caused by Cutibacterium acnes (60%). Younger age and prior shunts were the only predictors confirmed in multivariate Cox regression as significantly increasing the risk of revision surgery. Multivariate Cox regression analysis of infection risk factors showed that obstructive hydrocephalus, prior shunt, and cloxacillin significantly increased risk of shunt infection. We found revision and infection rates in accordance with other studies. We showed a significantly increased risk in younger patients. Previous shunts also increased the risk of revisions and infections. We showed a small but significant effect of perioperative prophylaxis with broader-spectrum antibiotics compared with cloxacillin. Our study identified a group of younger patients with congenital hydrocephalus and prior implants with an increased risk of shunt infection in whom additional preventive measures should be employed. [ABSTRACT FROM AUTHOR]

Background: Although recurrences after repair of giant paraesophageal hernias (PEH) are common, revisional procedures are challenging and associated with higher complication rates than primary repair. Therefore, repair of recurrent PEH is often avoided except in symptomatic patients. Data describing operative outcomes in these infrequent cases is lacking. Therefore, this study aimed to report and compare peri-operative outcomes of revisional PEH repair to similar patients undergoing primary surgery. Methods: A single-institution, retrospective cohort study was conducted on all adult patients undergoing primary repair of Type II–IV PEH and any revisional surgery for recurrent hiatal hernia after previous primary PEH repair (2012–2019). Patient and operative characteristics and post-operative outcomes were extracted from medical records. Patients were grouped into revisional (rPEH) and primary repair (pPEH). Coarsened exact matching was performed to create balanced cohorts. Results: A total of 347 cases were identified. The matched cohort included 234 patients (rPEH: 46, pPEH: 188). Patient sex and comorbidities were well balanced, while those who underwent revisions were younger (64 ± 13 vs. 69 ± 11 years; p = 0.01). Median time between primary and rPEH was 40[17–121] months. Incidence of emergency repair were similar among groups (rPEH: 9(15%), pPEH: 14(8%); p = 0.10). All revisional cases commenced laparoscopically with 7(15%) requiring conversion to open. The conversion rate was higher for rPEH than primary surgery (7(15%) vs. 3(2%); p < 0.01), with the most common reasons being adhesions and gastric fundus injury. Intra-operative complications occurred in 12(26%) revisional cases, of which 58% were gastric fundus injuries. Median length of stay was longer for rPEH than pPEH (2[1–5] vs. 1[1–2] day; p = 0.02). Incidence of severe complications (rPEH: 5(11%), pPEH: 11(6%); p = 0.23) and reoperations (rPEH: 2(4%), pPEH: 7(4%); p = 0.84) were similar between groups. There were no peri-operative deaths. Conclusion: In a high-volume tertiary care center, repair of recurrent giant paraesophageal hernias can be performed successfully laparoscopically in the majority of cases with acceptable morbidity and peri-operative outcomes in comparison to primary surgery. [ABSTRACT FROM AUTHOR]

Introduction: Prevalence of unexpected positive intraoperative cultures (UPIC) in revision total knee arthroplasty (TKA) is reported to be 8.32% with largely varying findings in individual studies (5.92–62.07%) due to a heterogeneity in preoperative diagnostic work-up and diagnostic criteria for periprosthetic joint infection (PJI). When diagnosed as unsuspected PJI, re-revision rate is reported to be as high as 18.45% compared to 2.94% in patients with UPIC classified as contamination (p = 0.0237). We performed a monocentric retrospective analysis of revision TKA surgery to determine prevalence of UPIC, risk of developing a subsequent PJI and re-revision rate after 24 months compared to those without UPIC. Materials and methods: All presumed aseptic total knee revision procedures from 2008 until 2017 were retrospectively reviewed. Single stage femorotibial revisions of TKA with at least 3 intraoperative cultures and a minimum follow-up of 24 months were included, whereas partial revisions or revisions from unicompartimental knee prosthesis to TKA were excluded. Demographic data were collected as well as initial reason for revision, preoperative aspiration results, micro-organism identified and postoperative antibiotics' administration. Primary outcome was survival rate after 24 months with differentiation based on UPIC interpretation: sterile, contamination, unsuspected PJI. Results: Of 256 included cases, 75 (29.3%) were found to have at least 1 UPIC during revision surgery, 72% of whom a single UPIC was found. Thirty-four cases (13.28%) were interpreted as unsuspected PJI and therefore treated with antibiotics. In total, 13 of the 256 patients (5.08%) had to be re-revised during follow-up with 7 PJI (2.73%), none of them developing reinfection defined as PJI with the same microorganism. A statistically significant trend towards earlier failure in the unsuspected PJI group compared to the contaminant group was not observed. However, a higher incidence of re-revisions attributed to septic reasons was noted in the former group. Conclusions: Presence of UPIC in presumed aseptic revision TKA does not correlate with a lower survival rate, but a higher incidence of subsequent PJI was observed in cases interpreted as unsuspected PJI. [ABSTRACT FROM AUTHOR]

Introduction: A decade ago, a comprehensive study was conducted to investigate the reasons for revision surgeries and their respective frequencies in cases of total hip arthroplasty (THA) and total knee arthroplasty (TKA) based on a complication-based analysis of joint replacement registries. The aim of the present study was to determine whether the causes and risks of their occurrence have changed over the last ten years and to present an updated analysis. Materials and methods: A systematic review of national arthroplasty registries from seven countries examined the causes and rates of revisions of THA and TKA. The study focused on a descriptive analysis that provided an updated overview without statistical significance values. Results: The most common causes for revisions of THA were aseptic loosening (35.1%), deep infection (18.2%), dislocation/instability (15.9%), and periprosthetic fractures (11.4%). The most common causes for revisions of TKA were deep infection (21.6%), aseptic loosening (18.3%), instability (14.1%), and pain (10.9%). Conclusion: The findings of this study revealed significant shifts in the underlying causes of revision surgeries in the last decade. Notably, septic complications emerged as the predominant reason for revision of primary TKA, while they also gained prominence as a cause of failure of THA. Although aseptic loosening remains the primary cause for re-operation of THA, the relative risk has decreased for both THA and TKA. [ABSTRACT FROM AUTHOR]

Introduction: Several risk factors for revision TKA have previously been identified, but interactions between risk factors may occur and affect risk of revision. To our knowledge, such interactions have not been previously studied. As patients often exhibit multiple risk factors for revision, knowledge of these interactions can help improve risk stratification and patient education prior to TKA. Materials and methods: The State Inpatient Databases (SID), part of the Healthcare Cost and Utilization Project (HCUP), were queried to identify patients who underwent TKA between January 1, 2006 and December 31, 2015. Risk factors for revision TKA were identified, and interactions between indication for TKA and other risk factors were analyzed. Results: Of 958,944 patients who underwent TKA, 33,550 (3.5%) underwent revision. Age, sex, race, length of stay, Elixhauser readmission score, urban/rural designation, and indication for TKA were significantly associated with revision (p < 0.05). Age was the strongest predictor (p < 0.0001), with younger patients exhibiting higher revision risk. Risks associated with age were modified by an interaction with indication for TKA (p < 0.0001). There was no significant interaction between sex and indication for TKA (p = 0.535) or race and indication for TKA (p = 0.187). Conclusions: Age, sex, race, length of stay, Elixhauser readmission score, urban/rural designation, and indication for TKA are significantly associated with revision TKA. Interaction occurs between age and indication. [ABSTRACT FROM AUTHOR]

Purpose: Understanding the mechanism and extent of preoperative deformity in revision procedures may provide data to prevent future failures in lumbar spinal fusion patients. Methods: ASD patients without prior spine surgery (PRIMARY) and with prior short (SHORT) and long (LONG) fusions were included. SHORT patients were stratified into modes of failure: implant, junctional, malalignment, and neurologic. Baseline demographics, spinopelvic alignment, offset from alignment targets, and patient-reported outcome measures (PROMs) were compared across PRIMARY and SHORT cohorts. Segmental lordosis analyses, assessing under-, match, or over-correction to segmental and global lordosis targets, were performed by SRS-Schwab coronal curve type and construct length. Results: Among 785 patients, 430 (55%) were PRIMARY and 355 (45%) were revisions. Revision procedures included 181 (23%) LONG and 174 (22%) SHORT corrections. SHORT modes of failure included 27% implant, 40% junctional, 73% malalignment, and/or 28% neurologic. SHORT patients were older, frailer, and had worse baseline deformity (PT, PI-LL, SVA) and PROMs (NRS, ODI, VR-12, SRS-22) compared to primary patients (p < 0.001). Segmental lordosis analysis identified 93%, 88%, and 62% undercorrected patients at LL, L1-L4, and L4-S1, respectively. SHORT patients more often underwent 3-column osteotomies (30% vs. 12%, p < 0.001) and had higher ISSG Surgical Invasiveness Score (87.8 vs. 78.3, p = 0.006). Conclusions: Nearly half of adult spinal deformity surgeries were revision fusions. Revision short fusions were associated with sagittal malalignment, often due to undercorrection of segmental lordosis goals, and frequently required more invasive procedures. Further initiatives to optimize alignment in lumbar fusions are needed to avoid costly and invasive deformity corrections. Level of evidence: IV Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding. [ABSTRACT FROM AUTHOR]

Purpose: To report the radiological and clinical outcomes of non-vascularized coracoid process autografts used for glenoid reconstruction during revision shoulder arthroplasty. Material and method: This is a retrospective, monocentric study from January 2016 to October 2022 targeting patients treated with a coracoid bone graft for glenoid reconstruction during revision of shoulder arthroplasty. The primary outcome measures were coracoid graft union rate and graft-implant osseointegration. Secondary outcome measures included clinical and CT-scan identified radiological complications and functional outcomes as measured by the Visual Analog Scale (VAS), Range of Motion (ROM), Subjective Shoulder Value (SSV), Constant score (absolute and ponderate), and ASES score. Results: Fifteen patients (9 males, 6 females; mean age 66.9 years, range 38–85) were included. At a mean follow-up of 20.9 months (range 12–56 months), 93.3% achieved complete graft integration. One case of partial lysis without baseplate loosening was noted. Regarding range of motion, the mean forward elevation was 130° (range 90°-170°), external rotation at the side 25° (range 10°-40°), external rotation in 90° of abduction 45° (range 10°-80°), and internal rotation 52° (range 10–80°). The mean VAS for pain was 1.1 (range 0–8), mean SSV 67.3% (range 40–90%), mean ASES score 85.5 (range 65–98.3), mean Absolute Constant score 58.6 (range 21–83), and mean Ponderate Constant score 77.5% (range 28.8–110.7%). No neurological injuries were reported. Conclusion: Utilizing a non-vascularized coracoid graft during shoulder arthroplasty revision is a safe, reproducible, and time-efficient technique that demonstrated satisfactory osseointegration, implant stability, good functional results, and a low complication rate. [ABSTRACT FROM AUTHOR]

Patients seek second facelifts either due to dissatisfaction with the primary procedure or years later after continued face and neck aging following successful first surgery. Previous surgical anatomical disruption, deformity of tension and vector, scar formation and skin excision compounded by the proliferation of historical energy-based skin treatments, thread lift procedures, and injectables make revision rhytidectomy a complex process of causal identification and surgical repair. Patients seeking revision due to dissatisfaction with a primary procedure, or worse visible deformity, have a heightened sense of anxiety which necessitates accurate diagnosis, careful examination, comprehensive documentation, and confidence in any planned secondary intervention as well as conservative expectation management. This article outlines the author's approach to identify the challenges posed and successfully perform secondary and revision rhytidectomy using a modified extended deep plane approach. [ABSTRACT FROM AUTHOR]

Purpose: Modular dual-mobility cups (MDMCs) have a lower risk for dislocation after total hip arthroplasty (THA). The primary aims of our study were to analyze implant survivorship and to determine complications, especially dislocation, and revision rates of primary THAs used for hip fracture patients and for revision THAs. Secondary aims were to evaluate mortality after MDMC surgery and to find out if introduction of MDMC at our institution (Kuopio University Hospital, Finland) have decreased dislocation rate. Methods: This retrospective cohort study consisted of 101 MDMC patients who were consecutively operated at our institution between April 1, 2018 and June 30, 2020. The implant survival rate, complications and mortality were evaluated with minimum of 2-year follow-up. Finnish Hospital Discharge Register was used to find out yearly dislocation rates following THA at our institution. Results: The cumulative estimate implant survival after MDMC in the primary THA group was 97% at 2 years, and in the revision THA group, it was 90% at 2 years. Dislocation was a rare complication in the primary THA group (1.4%), while it was common in revision THA group (12.9%). The cumulative estimate for mortality after MDMC in the primary THA group was 13% at 2 years, and in the revision group, it was also 13% at 2 years. The yearly number of patients who had re-hospitalization period due to THA dislocation decreased 46% after implementation of MDMC. Conclusion: Short-term survival and complication rates after MDMC were excellent after primary THA and moderate after revision THA. Implementation of MDMC THA for hip fracture patients seems to have effectively decrease dislocation rate during a short follow-up. [ABSTRACT FROM AUTHOR]

The current study replicated an earlier investigation by Bouwer and van der Veen (2023) where 10 Grade 5 and 6 classrooms in the Netherlands (210 students) were randomly assigned to a treatment or control condition, with treatment students evidencing improvements in the quality of their essays after practice writing argumentative essays, reading and discussing them with a small group of peers, and revising each essay based on the discussion that ensued. In the present study, 12 Grade 2 to 4 classrooms in Türkiye (383 students) were randomly assigned to this write, talk, and rewrite dialogic treatment or to a control condition. Students in the control condition practiced planning and writing the same four argumentative essays as treatment students did during the experiment, and each of these essays was shared with peers (time spent in both conditions was comparable). Control students did not, however, discuss their essay with peers or use such feedback to revise them as was done by students in the write, talk, and rewrite dialogic treatment. When the nested nature of the data and pretest scores were held constant, the quality of the argumentative posttest essays produced by students in the treatment condition evidenced greater improvement than essays written by control students. The same outcome was obtained for the length of essays (number of words) when the nested nature of the data and pretest scores were held constant. This investigation provided evidence that the write, talk, and rewrite dialogic intervention tested by Bouwer and van der Veen (2023) was effective in improving the argumentative writing of even younger students in a different country. Implications for research and practice are provided. [ABSTRACT FROM AUTHOR]

Fibromyalgia syndrome (FMS) frequently afflicts patients undergoing total shoulder arthroplasty (TSA), yet research investigating the effects of FMS on postoperative outcomes following TSA is lacking. The purpose of this study is to determine if patients with FMS are at increased risk for complications, readmission, revision, and mortality following primary elective TSA compared to a matched cohort of patients without FMS. The Nationwide Readmissions Database was queried from 2016 to 2020 to identify patients who underwent elective primary TSA. Patients were stratified into two groups based on the presence of preoperative FMS. Patients with FMS were matched 1:1 based on age, sex, and Charlson-Deyo Comorbidity Index using an optimized matching algorithm to patients without FMS to generate an equal sized control group for statistical comparison. 5506 matched pairs of patients with and without FMS were identified and used for statistical analysis. Preoperative demographic and comorbidity data, postoperative outcomes, and economic and hospital metrics were compared between the two groups. Multivariate analysis was conducted to control for the influence of independent risk factors other than FMS on postoperative outcomes. Patients with FMS were more likely to be active smokers (P <.001) and have chronic kidney disease (P <.001) prior to surgery. Patients with FMS exhibited increased rates of complications, including requiring a transfusion (P =.002), acute respiratory distress syndrome (P <.001), surgical site infection (P <.001), dislocation (P <.001), prosthetic loosening (P <.001), and fracture (P <.001) compared to patients without FMS. Patients with FMS also exhibited higher rates of all-cause complications (P <.001) and revision TSA (P <.001) and decreased rates of readmission (P =.002) within 180 days of surgery. Mean cost of admission was found to be $1639 higher in patients with FMS (P <.001), despite no difference in total hospital length of stay or discharge disposition. Patients with FMS are more likely to develop medical and surgical complications following primary TSA. Though associated with multiple comorbidities, FMS is an independent predictor of several adverse events. Orthopedic surgeons should be aware of the increased risk of FMS on TSA when determining treatment plans. [ABSTRACT FROM AUTHOR]

The volume of total shoulder arthroplasty (TSA) procedures has seen a remarkable surge over the past decade in the United States. Recent research has shown an association between depression and poorer postoperative outcomes following shoulder, hip, and knee arthroplasties. The purpose of this study was to examine the relationship between patients with a diagnosis of depression and/or anxiety and the risk of major postoperative complications after TSA. The TriNetX Research Network database was queried on May 30, 2023. Patient cohorts and outcomes were defined using International Classification for Disease, 10th Edition diagnosis codes and Current Procedural Terminology codes. After propensity score matching, the two cohorts were analyzed for differences in major outcomes within two years following the initial procedure. Of the 45,838 patients who underwent TSA identified in TriNetX, 15,074 patients were included in the depression/anxiety cohort and 30,764 were included in the no depression/anxiety cohort. Propensity score matching was performed to match 13,392 patients from each cohort. Compared to patients with no depression nor anxiety, patients with either depression and/or anxiety were identified to have a higher risk for dislocation (odds ratio [OR] 1.502, 95% confidence interval [CI] 1.285-1.756; P <.001), periprosthetic joint infection (OR 1.309, 95% CI 1.123-1.525; P =.001), periprosthetic fracture (OR 1.661, 95% CI 1.341-2.056; P <.001), and revision TSA (OR 1.316, 95% CI 1.150-1.506; P <.001) within 2 years after the initial procedure. Overall, this study showed that patients who have depression and/or anxiety have a higher risk for dislocation, periprosthetic joint infection, revision TSA, and periprosthetic fracture within two years after TSA. [ABSTRACT FROM AUTHOR]

When performing reverse total shoulder arthroplasty with compromised proximal bone fixation, surgeons must consider using specialized stems with a distal press-fit design. In this study, the authors report on the clinical and radiographic outcomes of patients who underwent surgical management with modular diaphyseal press-fit stems. In 2017-2021, patients who underwent revision reverse total shoulder arthroplasty reconstruction with diaphyseal press-fit stems (Aequalis Adjustable Stem [AS] or Aequalis Flex Revive Stem [RS]; Stryker, Kalamazoo, MI, USA) with minimum 1-year follow-up were identified. Patients with complex proximal humerus and scapula fractures, neurological injuries, and custom humeral replacements were excluded. Demographics and clinical follow-up data including range of motion, Visual Analog Scale (VAS), Simple Shoulder Test (SST), American Shoulder Elbow Surgeons (ASES) Score, and Single Assessment Numeric Evaluation were retrospectively reviewed. Postoperative radiographs were reviewed for aseptic humeral loosening, periprosthetic instability, stress shielding, periprosthetic fractures, and humeral stem failure. Sixty-five patients (29 AS and 36 RS) had mean follow-up of 25 months (standard deviation ± 16). Mean anterior elevation improved from 57° ± 39 preoperative to 121° ± 31 postoperatively. Mean external rotation improved from 3° ± 17 to 34° ± 16. Mean internal rotation improved from 4° ± 13 to 35° ± 26. Mean VAS improved from 6.7 ± 2.2 to 2.9 ± 1.5. Mean SST improved from 13% ± 13% to 65% ± 22%. Mean ASES score improved from 19 ± 13 to 60 ± 18. Mean Single Assessment Numeric Evaluation improved from 25% ± 18% to 71% ± 17%. There were statistically significant differences in mean postoperative VAS (P =.0017), SST (P =.025), and ASES score (P =.0228) in favor of the RS group. There were no other notable differences between groups. The most common complications were aseptic humeral stem loosening (24% vs. 3%, P =.018) and periprosthetic instability (10% vs. 6%, P =.649) for the AS and RS cohorts, respectively. There was no statistically significant difference between surgical revision rates between the AS and RS cohorts (24% vs. 8%, respectively. P =.096). Diaphyseal press-fit modular humeral stem can provide a viable surgical alternative in compromised proximal humeral bone. At short-term follow-up, the clinical and radiographic outcomes are comparable to other stem designs. Further studies are necessary to identify risks and causes of failure associated with modular diaphyseal press-fit stems. [ABSTRACT FROM AUTHOR]

As the prevalence of primary total shoulder arthoplasty (TSA) increases in the United States so does the number of revision TSA. Those undergoing primary TSA with lower nutritional status have been shown to have worse outcomes; however, little knowledge exists regarding the effects of malnutrition on outcomes following revision TSA. The purpose of this study is to determine the clinical outcomes and complication rates following revision TSA, as well as the prevalence of diabetes mellitus (DM) in malnourished patients undergoing revision TSA. The American College of Surgeons National Surgical Quality Improvement Program Database was queried from 2013 to 2020 and found 783 cases of revision TSA. Albumin was used as a surrogate marker for nutritional status. Patients were stratified into unmatched cohorts of normal (albumin ≥ 3.5 g/dL, n = 700) and low (albumin < 3.5 g/dL, n = 83) nutritional status, as well as by diagnosis of DM. Comparative differences in demographics, comorbidities, length of stay (LOS), readmission, reoperation, and 30-day postoperative complications related to their nutritional status and presence of DM were analyzed using chi-squared tests, independent sample t tests, and multivariate analysis on SPSS. Patients within the low albumin cohort were more likely to be female (P =.008), increased mean age (P =.018), on dialysis (P =.002), had undergone an emergency procedure (P <.001), classified with a dependent functional status (P <.001), and had a higher American Society of Anesthesiologists classification (P <.001). There was a higher percentage of patients with a DM diagnosis and hypoalbuminemia compared to nondiabetic patients (36.2% vs. 19.4%, P <.001). Compared to the normal albumin cohort, the low albumin cohort was found to have significantly longer LOS (P =.025), increased bleeding/transfusion complications (8.4% vs. 3.3%, P =.021), and increased reoperation rate (8.4% vs. 0.71%, P =.034). No significant difference in readmission was found (P =.226). Eleven percentage of patients undergoing revision TSA were malnourished and had higher LOS and reoperation rates. Patients with DM had a significantly higher incidence of being malnourished than those without DM. Malnourishment represents a potential modifiable risk factor for patients undergoing revision TSA, and surgeons should screen patients preoperatively, especially those patients with DM. [ABSTRACT FROM AUTHOR]

The role of arthroscopic Latarjet stabilization after failed arthroscopic Bankart repair has yet to be definitively established and merits further investigation. To assess clinical and radiological outcomes after arthroscopic Latarjet stabilization as a revision procedure for failed Bankart repair, as well as the return to athletic activity and complication rates. Between 2009 and 2020, patients with a previous failed arthroscopic Bankart repair who were treated with an arthroscopic Latarjet were retrospectively evaluated. Clinical outcomes at a minimum of 24 months postoperatively included the Rowe score, Western Ontario Shoulder Instability Index, Constant-Murley Shoulder Outcome score, and Single Assessment Numeric Evaluation. Dislocations, subluxations, complications, pre- and postoperative levels of activity, and degree of osteoarthritis were also assessed. A total of 77 patients, with a mean age at revision surgery of 31.2 ± 9.1 years and with either 1 (n = 59), 2 (n = 13), or 3 (n = 4) previous arthroscopic stabilizations, who underwent revision surgery using an arthroscopic Latarjet procedure were studied. Postoperatively, the mean Rowe and Constant-Murley Shoulder Outcome scores increased from 41.8 ± 16 to 90.7 ± 14.3 (P <.001) and from 50.5 ± 13.8 to 90.5 ± 10.3 (P <.001), respectively. Western Ontario Shoulder Instability Index decreased from 1247 ± 367.6 to 548.9 ± 363 at the final follow-up (P <.001). After a mean follow-up of 39.6 ± 23.1 months, 64 shoulders (83.1%) were subjectively graded as good to excellent using the Single Assessment Numeric Evaluation score. Grade 1, 2, and 3 osteoarthritis, according to Ogawa et al, was found in 18 (23.4%), 6 (7.8%), and 3 (3.9%) shoulders, respectively. Six (7.8%) dislocations after revision surgery were reported. In 4 failed cases, an Eden-Hybinette procedure was conducted, and in the remaining 2 patients, an arthroscopic extra-articular anterior capsular reinforcement was performed. A significantly decreased level of athletic activity was observed postoperatively (P =.01). Arthroscopic Latarjet for the revision of failed arthroscopic Bankart repair provides satisfactory patient-reported subjective outcomes with a low rate of recurrences and complications. However, a decreased level of athletic activity is expected. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the clinical and radiographic outcomes of arthroscopic anatomic glenoid reconstruction (AAGR) used for primary vs. revision surgery for addressing anterior shoulder instability with bone loss. We performed a retrospective review on consecutive patients who underwent AAGR from 2012 to 2020. Patients who received AAGR for anterior shoulder instability with bone loss and had a minimum follow-up of 2 years were included. Exclusion criteria included patients with incomplete primary patient-reported outcome scores (PROs), multidirectional instability, glenoid fracture, nonrigid fixation and concomitant humeral avulsion of the glenohumeral ligament, or rotator cuff repair. Our primary outcome was measured using the Western Ontario Shoulder Instability Index (WOSI) scores. Secondary outcomes included postoperative Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) scores, complications, recurrence of instability and computed tomographic (CT) evaluation of graft position, resorption, and healing. There were 73 patients (52 primary and 21 revision) finally included. Both groups had comparable demographics and preoperative WOSI and DASH scores. The primary group had significantly better postoperative WOSI and DASH scores at final follow-up when compared to the revision group (WOSI: 21.0 vs. 33.8, P =.019; DASH: 7.3 vs. 17.2, P =.001). The primary group also showed significantly better WOSI scores than the revision group at the 6-month, 1-year, and 2-year time points (P =.029,.022, and.003, respectively). The overall complication rate was 9.6% (5 of 52) in the primary group and 23.8% (5 of 21) in the revision group. Both groups showed good graft healing and placement in the anterior-to-posterior and mediolateral orientation and had a similar rate of graft resorption and remodeling. There was no difference between the groups in the remainder of the CT measurements. Functional outcome scores and stiffness were significantly worse in patients undergoing an AAGR procedure after a failed instability surgery when compared with patients undergoing primary AAGR. There were no differences in postoperative recurrence of instability or radiographic outcomes. As a result, AAGR should be considered as a primary treatment option within current treatment algorithms for shoulder instability. [ABSTRACT FROM AUTHOR]

Purpose of Review: To examine preoperative diagnostic tools for evaluating artificial urinary sphincter failure and operative techniques for device revision. We focus our discussion of device revision on stepwise approaches for the replacement of individual components versus the replacement of the entire device. Recent Findings: Although the AUS has not changed significantly since its inception nearly 50 years ago, there have been a variety of proposed approaches to the assessment and management of failed devices, particularly in how each component is treated at the time of revision surgery. Summary: Need for revision surgery is a well-known risk of AUS placement. Despite ongoing research regarding etiologies of device failure and surgical approaches to address such problems, there is no universally accepted standardized approach to management of component failure. Future studies should be aimed at preoperative diagnostic tests that can better elucidate the etiology of device failure and expand upon indications for single-component versus whole-device replacement. [ABSTRACT FROM AUTHOR]

Pain after trapeziectomy is a vexing problem, most commonly due to scaphometacarpal impingement. A number of treatment strategies have been described and are examined in this systematic review. In total, 27 studies describing revision surgery for unsatisfactory results after trapeziectomy were included. Results after soft tissue or synthetic suspensionplasties, arthrodesis procedures, implant arthroplasty and costochondral autografting were included. Most studies were heterogeneous in terms of patient selection and procedure performed, and the level of evidence and methodological quality were uniformly low. Autologous suspensionplasty procedures are the best studied and most rigorously reported techniques, with modest improvements in pain widely reported. Newer techniques using synthetic suture button suspension are encouraging with the benefit of earlier mobilization but require further study. Due to high incidences of complication and revision, the literature does not support the use of implant arthroplasty after trapeziectomy. Arthrodesis appears to be a reasonable last resort when attempts at suspension have failed. [ABSTRACT FROM AUTHOR]

The diversity of radiolarian species of the family Carpocaniidae Haeckel, 1881, emend. Riedel, 1967, from the surface sediments of the Emperor Seamount Chain (Nintoku, Jingū, Ojin, Koko and Yuryaku guyots) is analyzed. Five new species of the genus Carpocanium Ehrenberg, 1847, emend. nov.: C. rotundum sp. nov., C. fragaria sp. nov., C. alabastrum sp. nov., C. tulipa sp. nov., and C. fungus sp. nov. are described. The identification of the new species is based on their morphology, which differs from that of other species of the genus Carpocanium. It is proposed to restore Carpocanarium Haeckel, 1887 to a valid genus, and transfer it back into the family Carpocaniidae, based on the overall correspondence of its morphology to the diagnosis of this family. [ABSTRACT FROM AUTHOR]

The so-called 'bad' quarto editions of Shakespeare's plays have long been treated as superfluous. However, recent debates suggest that these publications are not corrupt but may instead be Shakespeare's early drafts, opening up a conversation about how to treat the textual disparities between the early quartos and the 1623 folio. This article examines two variant texts in light of this assessment. The early quartos of The Merry Wives of Windsor (1602) and Henry V (1600) offer moments where female characters display an agency that is silenced and controlled in the more canonical texts of the folio, suggesting that, as he revised the plays, Shakespeare moved to restrict women's behaviour. For example, the titular Merry Wives design and orchestrate the final masque in the quarto text of that play, while they cede artistic control to their husbands in the later folio version. So too, in Henry V, Katherine's final scene in the quarto gives her the opportunity to speak more and to assert an equality with Henry in a passage unique to that text. Attention to the gender dynamics of revision demonstrates that, to understand the full range of feminist potential within Shakespeare's canon, scholars must explore his plays' textual variation. [ABSTRACT FROM AUTHOR]

Despite the commercial success of Enid Blyton's books in Spain, researchers have not paid much attention to the Spanish revisions and retranslations of her work. This paper focuses on two of Blyton's most popular series, The Famous Five and Malory Towers. They were first translated into Spanish in 1964 and have been recently republished in Spain, partly because from 2010 onwards the STs have been thoroughly revised. We analyse which (para)textual aspects of both the original texts and their first translations into Spanish have been modified allegedly to fit the preferences of modern readers. Findings show that two different strategies, revision and retranslation, have been used by publishers for the same purpose: the revamping of Blyton's works in modern-day UK and Spain. [ABSTRACT FROM AUTHOR]

Copyright of GeSec: Revista de Gestao e Secretariado is the property of Sindicato das Secretarias e Secretarios do Estado de Sao Paulo (SINSESP) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The Late Cretaceous Bagaraatan ostromi , described by Osmólska in 1996, is one of the most enigmatic theropod dinosaurs. The holotype possesses a peculiar combination of features, which Osmólska suggested were indicative of a primitive position among theropods that could not be resolved further. Other researchers have pointed to affinities with either derived bird-like coelurosaurs or tyrannosaurids. Here, we reanalyse all material collected by Osmólska, which reveals it to be a chimaera of multiple theropod taxa. The femur, tibiotarsus, one pedal phalanx, and most of the bones undescribed in Osmólska's paper are identified as Caenagnathidae indet. The mandible, cervical vertebrae, pelvis, tail, and one pedal phalanx, which we consider the holotype of B. ostromi , show tyrannosaurid affinities, which are here supported by phylogenetic analyses. We find only two potentially unique diagnostic features of the Bagaraatan holotype: double surangular foramina and a horizontal ridge on the lateral surface of the postacetabular process of the ilium. Both, however, may be ontogenetically or intraspecifically variable, and thus we conclude that the holotype of B. ostromi represents an indeterminate tyrannosaurid. The small size of the holotype and its possession of many features known to characterize juvenile Tyrannosaurus rex indicate that the skeleton belongs to a juvenile, which is one of the smallest juvenile tyrannosaurids currently known. [ABSTRACT FROM AUTHOR]

Graft failure is a common complication of cranioplasty. Revision cranioplasty is required to overcome this complication. However, no previous studies have reported outcomes in revision cranioplasty with 3-dimensional (3D) custom-made titanium implants. We describe our experience with 3D titanium implants in patients with revision cranioplasty. We evaluated 43 consecutive patients between January 2011 and December 2019 who underwent revision cranioplasty using 3D custom-made titanium implants. The 3D image of the patient's cranium and the plan to close the cranium defect were created in a virtual environment using software programs. Demographic and radiologic features were compared based on the materials used in the initial cranioplasty. Previous material was autologous graft (AG) in 27 patients and polymethyl methacrylate (PMMA) in 16 patients. The mean time without revision cranioplasty is longer in patients with PMMA implants than in patients with AG. There was no statistically significant difference in the length of hospital stay between patients with PMMA implants and patients with AG. There were no postoperative adverse events such as infection, wound dehiscence, convulsions, or epidural hematoma in 38 patients during hospitalization. Wound dehiscence developed in 5 patients and surgical repair was required in one. Initial cranioplasty with PMMA provides a longer time period than the AG before the revision. However, both of them have similar outcomes based on length of hospital stay and cranial defect area. Custom-made 3D titanium implant is a good option for revision cranioplasty to prevent implant failure and reduce patients' cosmetic concerns. [ABSTRACT FROM AUTHOR]

This article describes a major capstone course centered on public writing, whose underlying pedagogical principles are transferable to courses across the curriculum. The course aims to strengthen students' mathematical agency and their ability to effectively communicate mathematical ideas. In its unique format, students repeatedly take turns writing articles aimed at a variety of audiences and editing peers' work. Student reflections and survey data demonstrate that this collaborative, active format builds students' confidence in math and writing and their sense of belonging in the mathematical community. The last section offers suggestions for getting started with implementing aspects of this pedagogy. [ABSTRACT FROM AUTHOR]

Nationa Medical Commission (NMC) had recently undertook the revision of Undergraduate CBME curriculum. the Authors were involved in Psychiatry curriculum revision. In this paper,authors explain the process of revision, the rationale behind the changes made and make specific suggestions for the better implementation of the revised curriculum. [ABSTRACT FROM AUTHOR]

This paper comprehensively compares open and closed rhinoplasty techniques. Its focus is surgical outcomes, patient satisfaction, postoperative symptoms, complication rates, reoperation and revision rates, and reasons for revisions. A literature search using identified keywords was conducted, targeting articles related to open and closed rhinoplasty techniques and outcomes. MEDLINE through PubMed served as the primary source.Both techniques present distinct advantages and limitations. Open rhinoplasty provides better exposure and visualization of nasal anatomy, enabling accurate deformity assessment, precise maneuvers, and grafting. In contrast, closed rhinoplasty is less invasive, with shorter surgical time and reduced psycho-social distress. Postoperative symptoms were comparable, but closed rhinoplasty may perform better in nasal hypoesthesia. Complication rates were low for both techniques, but further evidence is needed. Reoperation and revision rates had no clear superiority for either technique. Common reasons for revision were tip and nasal base issues for open rhinoplasty and dorsum and valve problems for closed rhinoplasty. Patient satisfaction was generally high, though open rhinoplasty may be limited by columellar scar. In conclusion, this study provides valuable insights about advantages and limitations of open and closed rhinoplasty techniques, aiding in selecting most suitable approach based on individual factors and desired outcomes. Future research should address limitations and provide evidence for optimizing rhinoplasty procedures and maximizing patient satisfaction. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to identify the differences in anatomical factors between the patients who underwent revision and primary anterior cruciate ligament reconstructions (ACLR) and compare the outcomes between the 2 surgeries. Design: Retrospective cohort study. Setting: Single institution tertiary academic center between 2014 and 2020. Patients: A total of 84 matched patients who underwent revision (group I) or primary ACLR (group II). Interventions: Radiological evaluations were performed using side-to-side differences (SS-D), femorotibial angle, and posterior tibial slope. The medial meniscus posterior horn status as width (MMPHW), medial tibial plateau width (MTPW), notch configurations, tunnel positions, and sagittal graft angle were measured using 3D-CT and magnetic resonance imaging (MRI). MainOutcomeMeasures: Graft signals were assessed using MRI. The clinical outcomes were assessed. Results: Group I showed larger SS-D and higher mean Howell grade of anterior cruciate ligament (ACL) graft than group II (P50.002 and P50.004, respectively). Multivariate regression analyses showed that the decreased MMPHW/MTPW ratio (P 5 0.010) and notch width index (P, 0.007) were significantly independent factors associated with the higher Howell grade of ACL grafts. The decreased MMPHW/MTPW ratio (P<0.001) was a significantly independent factor associated with larger SS-D. In the subgroup analysis, all patients in the notchplasty group showed wider notches postoperatively (P, 0.001). Conclusions: Revision ACLRs resulted in worse ACL signal intensity and stability outcome. The results of this study suggest that it may be important to preserve the MMPHW as much as possible and check notch configurations, especially during a revision ACLR. [ABSTRACT FROM AUTHOR]

This review article will cover both general aspects of hand infections and the most common superficial hand infections. Hand and wrist infections are commonly encountered in clinical practice both by the generalist orthopaedic surgeon and the hand surgeon. Clinically, they appear as a spectrum, from easy to resolve superficial infections, to life and limb threatening deep infections (for example, necrotizing fasciitis). Multiple pathogens can be the causative agents of hand infections (virus, fungi, parasites, mycoplasma, bacterias and mycobacteria). Continuous and prolonged exposure of the hands to the environment expose them to several kinds of infection. [ABSTRACT FROM AUTHOR]

Objective: The craniovertebral junction (CVJ) presents intricate anatomical challenges. In severe or irreducible malformations, complications such as reduction loss and fixation failure may occur, necessitating revision surgery. The posterior facet joint distraction and fusion (PFDF) technique, offers a solely posterior approach for revisions. Hence, we delineate varied revision scenarios, proposing surgical strategies and technical details to enhance outcomes and mitigate risks, thereby enriching the neurosurgical community's repertoire. Methods: This was a retrospective cohort study, analyzed patient data from Xuanwu Hospital, between 2017 to 2023. All patients had a history of surgical treatment for CVJ malformations, and experienced failure or loss of reduction. The distance from the odontoid process tip to the Chamberlain's line (DCL), the atlantodental interval (ADI), clivus‐canal angle, cervicomedullary angle, width of subarachnoid space, CVJ area, and width of syrinx were used for radiographic assessment. Japanese Orthopaedic Association (JOA) scores and SF‐12 scores were used for clinical assessment. Independent sample t‐tests were employed. A significance level of p < 0.05 indicates statistically significant differences. Results: We analyzed data from 35 patients. For patients who underwent PFDF, the postoperative DCL, ADI, and clivus‐canal angle significantly improved. For all patients, the postoperative cervicomedullary angle, width of subarachnoid space, CVJ area, and width of syrinx all demonstrated significant improvement, indicating the relief of neural compression. All patients showed significant improvement in both symptoms and clinical assessments. Conclusion: Severe atlantoaxial joint locking or ligament contracting are the fundamental cause of reduction and fixation failure. Anterior odontoidectomy is indicated for patients with robust bony fusion of the atlantoaxial joint in an unreduced position. The PFDF technique is safe and effective for patients with incomplete atlantoaxial bony fusion. Preoperative assessment of surgical feasibility and vertebral artery status ensures surgical safety and efficacy. [ABSTRACT FROM AUTHOR]

Background: Revision anterior cruciate ligament (ACL) reconstruction has been documented to have inferior outcomes compared with primary ACL reconstruction. The reasons why remain unknown. Purpose: To determine whether surgical factors performed at the time of revision ACL reconstruction can influence a patient's outcome at 6-year follow-up. Study Design: Cohort study; Level of evidence, 2. Methods: Patients who underwent revision ACL reconstruction were identified and prospectively enrolled between 2006 and 2011. Data collected included baseline patient characteristics, surgical technique and pathology, and a series of validated patient-reported outcome instruments: Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) subjective form, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Marx activity rating score. Patients were followed up for 6 years and asked to complete the identical set of outcome instruments. Regression analysis was used to control for baseline patient characteristics and surgical variables to assess the surgical risk factors for clinical outcomes 6 years after surgery. Results: A total of 1234 patients were enrolled (716 men, 58%; median age, 26 years), and 6-year follow-up was obtained on 79% of patients (980/1234). Using an interference screw for femoral fixation compared with a cross-pin resulted in significantly better outcomes in 6-year IKDC scores (odds ratio [OR], 2.2; 95% CI, 1.2-3.9; P =.008) and KOOS sports/recreation and quality of life subscale scores (OR range, 2.2-2.7; 95% CI, 1.2-4.8; P <.01). Use of an interference screw compared with a cross-pin resulted in a 2.6 times less likely chance of having a subsequent surgery within 6 years. Use of an interference screw for tibial fixation compared with any combination of tibial fixation techniques resulted in significantly improved scores for IKDC (OR, 1.96; 95% CI, 1.3-2.9; P =.001); KOOS pain, activities of daily living, and sports/recreation subscales (OR range, 1.5-1.6; 95% CI, 1.0-2.4; P <.05); and WOMAC pain and activities of daily living subscales (OR range, 1.5-1.8; 95% CI, 1.0-2.7; P <.05). Use of a transtibial surgical approach compared with an anteromedial portal approach resulted in significantly improved KOOS pain and quality of life subscale scores at 6 years (OR, 1.5; 95% CI, 1.02-2.2; P ≤.04). Conclusion: There are surgical variables at the time of ACL revision that can modify clinical outcomes at 6 years. Opting for a transtibial surgical approach and choosing an interference screw for femoral and tibial fixation improved patients' odds of having a significantly better 6-year clinical outcome in this cohort. [ABSTRACT FROM AUTHOR]

Objectives: The increase in the number of arthroplasty surgeries worldwide also leads to an increase in revision surgeries. This study examines the costs of primary and revision arthroplasty treatments in a tertiary university hospital's orthopedics and traumatology clinic. It also explores the impact of revision surgeries on the healthcare system. Methods: Seventy-six patients who had total knee arthroplasty at a university hospital between 01.01.2017 and 30.09.2022 were included in the study. The patients were divided into three groups: primary (n=25), aseptic reasons one-stage revision (n=27), and septic reasons two-stage revisions (n=24). For each patient included in the study, detailed documents regarding medical supplies, anesthesia, operating room, intensive care, consultation, medicine/serum, medical treatment, laboratory, blood and blood products, microbiology, radiology, food, bed, and attendant fees were provided separately by the hospital purchasing and statistics departments. Results: When comparing the costs of primary, one-stage revision, and two-stage revision surgeries, the average costs were 5689 Turkish Lira (₺), 8294.97 ₺, and 40919.67 ₺, respectively. In patients with septic reasons, the group that underwent two-stage revisions had significantly higher costs than the aseptic group in terms of surgery time, hospital stay duration, medication, treatment, surgery, anesthesia, intensive care, laboratory tests, imaging, blood center services, consultations, visits, meal expenses, and invoiced amount (P<0.001). Conclusion: Preventing and treating periprosthetic infections is costly and challenging. We need more research to develop effective protocols and reduce costs. As the number of patients undergoing knee arthroplasty is expected to rise, healthcare systems must ensure the sustainability of public financial resources, especially in public university hospitals. [ABSTRACT FROM AUTHOR]

Purpose: To validate the New Zealand Anterior Cruciate Ligament (ACL) Registry's capture rate of revisions by cross‐referencing Registry data with reoperations data recorded by the Accident Compensation Corporation (ACC) and identify risk factors for all‐cause reoperation. Methods: Primary ACL reconstructions performed between April 2014 and September 2019 were individually matched on a record‐by‐record basis between the two databases. The ACC database was used to identify patients who underwent a reoperation with manual review of operation notes to identify whether a revision or other procedure was performed. This was combined with the number of revisions separately recorded in the New Zealand ACL Registry, which was used as the denominator value to calculate the Registry's capture rate of revisions. Patient and surgical data recorded in the Registry were analysed to identify independent predictors for all‐cause reoperation. Results: A total of 8046 primary ACL reconstructions were matched between the New Zealand ACL Registry and the ACC databases. The reoperation rate was 8.9% (n = 715) at a mean follow‐up of 2.5 years. Meniscal‐related procedures were the most common reoperation (n = 299, 3.7%), followed by revision ACL reconstruction (n = 219, 2.7%), arthrofibrosis (n = 185, 2.3%), cartilage (n = 56, 0.7%) and implants (n = 32, 0.4%). The New Zealand ACL Registry captured 96% of revisions. Younger age (hazard ratio [HR] > 1.4, p < 0.001), earlier surgery (HR > 1.3, p = 0.05), concurrent meniscal repair (medial meniscus HR = 1.9, p < 0.001 and lateral meniscus HR = 1.3, p = 0.022) and hamstring tendon autografts (HR = 1.4, p = 0.001) were associated with a higher risk of reoperation. Conclusion: The New Zealand ACL Registry captured 96% of revisions. Risk factors for all‐cause reoperation included younger age, earlier surgery, meniscal repair and hamstring tendon autografts. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

In transgender or non-binary patients (TGNB) with failed penile inversion vaginoplasty (PIV), peritoneal flap vaginoplasty (PFV) and intestinal segment vaginoplasty (ISV) facilitate restoration of neovaginal depth and sexual function. This study compared the outcomes of revision PFV and ISV in TGNB patients with failed PIV. TGNB patients who underwent secondary PFV or ISV from December 2018 to April 2023 were reviewed. Twenty-one (5.8%) patients underwent secondary PFV and 24 (6.6%) underwent secondary ISV, due to vaginal stenosis (n = 45, 100.0%). Mean duration to first successful dilation and average vaginal depth were comparable between the groups. Seven (33.3%) PFV patients experienced short-term complications, including introital dehiscence (n = 2, 9.5%), vaginal stenosis (n = 2, 9.5%), vaginal bleeding (n = 2, 9.5%), and reoperation (n = 2, 9.5%). Nine (42.9%) experienced long-term complications, including urethrovaginal fistula formation (n = 2, 9.5%), hypergranulation (n = 2, 9.5%), vaginal stenosis (n = 7, 33.3%), and reoperation (n = 6, 28.6%). Ten (41.7%) ISV patients experienced short-term complications, including dehiscence (n = 4, 19.0%), ileus (n = 2, 8.3%), introital stenosis (n = 2, 9.5%), and reoperation due to vaginal bleeding (n = 2, 8.3%). Six (25.0%) experienced long-term complications, including introital stenosis (n = 3, 12.5%), mucosal prolapse (n = 2, 8.3%), and reoperation due to mucosal prolapse (n = 4, 16.7%). Secondary PFV had a higher rate of vaginal stenosis (p = 0.003). There were no cases of partial or full-thickness flap necrosis. Revision PFV and ISV represent viable techniques for addressing vaginal stenosis secondary to PIV. Although PFV and ISV had comparable rates of short-term complications, ISV demonstrated a lower incidence of recurrent vaginal stenosis, which may inform operative decision-making. [ABSTRACT FROM AUTHOR]

Several studies have suggested that spinal anesthesia gives superior outcomes for primary total joint arthroplasty (TJA). However, there is a lack of available data regarding contemporary general anesthesia (GA) approaches for revision TJA utilized at high-volume joint arthroplasty centers. We retrospectively reviewed a series of 850 consecutive revision TJAs (405 revision total hip arthroplasties and 445 revision total knee arthroplasties) performed over 4 years at a single institution that uses a contemporary GA protocol and reported on the lengths of stay, early recovery rates, perioperative complications, and readmissions. Of the revision arthroplasty patients, 74.4% (632 of 850) were discharged on postoperative day 1 and 68.5% (582 of 850) of subjects were able to participate in physical therapy on the day of surgery. Only 6 patients (0.7%) required an intensive care unit stay postoperatively. The 90-day readmission rate over this time was 11.3% (n = 96), while the reoperation rate was 9.4% (n = 80). While neuraxial anesthesia is commonly preferred when performing revision TJA, we have demonstrated favorable safety and efficiency metrics utilizing GA in conjunction with contemporary enhanced recovery pathways. Our data support the notion that modern GA techniques can be successfully used in revision TJA. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Defense Sciences / Savunma Bilmleri Dergisi is the property of Turkish Military Academy Defense Sciences Institute and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Psicoterapia is the property of Revista de Psiquiatria y Psicologia Humanista, S.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The translation attempts to re-express messages from one language into another by prioritizing the equivalence of meaning, primarily determined by the translator's ability to understand the source text and the target text. Translators use revision to solve problems in the text to be translated. Revision is part of a translator's cognitive ability, which includes re-examining the translation results and looking for internal and external reading sources to get the right message or information in the source text. This study aims to explain the revisions made by the translator to the source text, namely Mandarin into Indonesian as the target text, and the reading sources they used in translating the text. This qualitative descriptive study employs a triangulation strategy: interviews, observations, and field notes with two students in the 7th semester of the Mandarin Language study program, Universitas Sumatera Utara, as participants. The findings show that student translators perform several revisions, such as Word substitution, Meaning Correction, Word addition, Grammar Correction, Deletion, and Spelling Correction. During the revision, they used online reading sources to find the terms used in the target text, such as Google Translate, KBBI, and Wikipedia. In translation, the revision of the source text aims to make the information in the target text easy for readers to understand. [ABSTRACT FROM AUTHOR]